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Intervention Review

Emergency ultrasound-based algorithms for diagnosing blunt abdominal trauma

  1. Dirk Stengel1,*,
  2. Kai Bauwens2,
  3. Jalid Sehouli3,
  4. Grit Rademacher4,
  5. Sven Mutze5,
  6. Axel Ekkernkamp6,
  7. Franz Porzsolt7

Editorial Group: Cochrane Injuries Group

Published Online: 20 APR 2005

Assessed as up-to-date: 18 FEB 2008

DOI: 10.1002/14651858.CD004446.pub2


How to Cite

Stengel D, Bauwens K, Sehouli J, Rademacher G, Mutze S, Ekkernkamp A, Porzsolt F. Emergency ultrasound-based algorithms for diagnosing blunt abdominal trauma. Cochrane Database of Systematic Reviews 2005, Issue 2. Art. No.: CD004446. DOI: 10.1002/14651858.CD004446.pub2.

Author Information

  1. 1

    Unfallkrankenhaus Berlin, Centre for Clinical Research, Department of Trauma and Orthopaedic Surgery, Berlin, Germany

  2. 2

    Unfallfrankenhaus Berlin, Department of Trauma, 12683 Berlin, Germany

  3. 3

    Charité-Virchow University Hospital, Department of Gynaecology & Obstetrics, 13353 Berlin, Germany

  4. 4

    Unfallkrankenhaus Berlin, Institute of Diagnostic & Interventional Radiology, 12683 Berlin, Germany

  5. 5

    Unfallfrankenhaus Berlin, Institute of Diagnostic & Interventional Radiology, 12683 Berlin, Germany

  6. 6

    Ernst-Moritz-Arndt University Hospital, Department of Trauma Surgery, 17487 Greifswald, Germany

  7. 7

    Ludwig-Maximilians - University of Munich, Evidence-Based Health Care Working Group, Munich, Germany

*Dirk Stengel, Centre for Clinical Research, Department of Trauma and Orthopaedic Surgery, Unfallkrankenhaus Berlin, Warener Str 7, Berlin, 12683, Germany. stengeldirk@aol.com.

Publication History

  1. Publication Status: New search for studies and content updated (no change to conclusions)
  2. Published Online: 20 APR 2005

SEARCH

This is not the most recent version of the article. View current version (31 JUL 2013)

 

Abstract

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Background

Ultrasonography is regarded as the tool of choice for early diagnostic investigations in patients with suspected blunt abdominal trauma. Although its sensitivity is too low for definite exclusion of abdominal organ injury, proponents of ultrasound argue that ultrasound-based clinical pathways enhance the speed of primary trauma assessment, reduce the number of computed tomography scans and cut costs.

Objectives

To assess the efficiency and effectiveness of trauma algorithms that include ultrasound examinations in patients with suspected blunt abdominal trauma.

Search methods

We searched the Cochrane Injuries Group's Specialised Register, CENTRAL, MEDLINE, EMBASE, CINAHL, publishers' databases, controlled trials registers and the Internet. Bibliographies of identified articles and conference abstracts were searched for further elligible studies. Trial authors were contacted for further information and individual patient data.The searches were last updated in January 2008.

Selection criteria

Studies: randomised controlled trials (RCTs) and quasi-randomised trials (qRCTs). Participants: patients with blunt torso, abdominal or multiple trauma undergoing diagnostic investigations for abdominal organ injury. Interventions: diagnostic algorithms comprising emergency ultrasonography (US). Controls: diagnostic algorithms without US ultrasound examinations (for example, primary computed tomography [CT] or diagnostic peritoneal lavage [DPL]). Outcome measures: mortality, use of CT and DPL, cost-effectiveness, laparotomy and negative laparotomy rates, delayed diagnoses, and quality of life.

Data collection and analysis

Two authors independently selected trials for inclusion, assessed methodological quality and extracted data. Where possible, data were pooled and relative risks (RRs), risk differences (RDs) and weighted mean differences, each with 95% confidence intervals (CIs), were calculated by fixed- or random-effects modelling, as appropriate.

Main results

We identified four studies meeting our inclusion criteria. Overall, trials were of moderate methodological quality. Few trial authors responded to our written inquiries seeking to resolve controversial issues and to obtain individual patient data. We pooled mortality data from three trials involving 1254 patients; relative risk in favour of the US arm was 1.00 (95% CI 0.50 to 2.00). US-based pathways significantly reduced the number of CT scans (random-effects RD -0.52, 95% CI -0.83 to -0.21), but the meaning of this result is unclear. Given the low sensitivity of ultrasound, the reduction in CT scans may either translate to a number needed to treat or number needed to harm of two.

Authors' conclusions

There is currently insufficient evidence from RCTs to justify promotion of ultrasound-based clinical pathways in diagnosing patients with suspected blunt abdominal trauma.

 

Plain language summary

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

No evidence in favour of using ultrasound to aid diagnosis of patients with a 'blunt' injury to the abdomen

Many people admitted to hospital after an injury have 'blunt' (that is, not penetrating) damage to the abdomen. Doctors treating these patients need to know whether the organs within the abdomen have been injured. Ultrasound scans are believed to help diagnose the patient's condition. In this review, the authors looked for studies that compared death rates in patients with an abdominal injury where ultrasound was used to aid diagnosis with death rates where no ultrasound was used. They also looked for evidence that ultrasound use could reduce the need to carry out other more complex and more expensive diagnostic tests. However, very few trials have been done and the authors conclude there is insufficient evidence to justify the use of ultrasound as part of the diagnosis of patients with abdominal injury.

 

摘要

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

背景

緊急超音波為基礎的流程圖來診斷腹部頓傷

超音波被認為是早期評估懷疑有腹部頓傷的診斷工具之一,雖然它的敏感性太低,無法肯定的排除腹部器官受傷,超音波支持者認為超音波為基礎的臨床路徑增加初步創傷評估的速度,減少電腦斷層的數量並減少醫療費用。

目標

評估包括超音波檢查在疑似腹部頓傷患者之創傷臨床路徑的效率及有效性。

搜尋策略

我們搜尋Cochrane Injyries Group's speciaised register, CENTRAL, MEDLINE, EMBASE, CCMED, publishers' databases, controlled trials registers and the Internet。手工搜尋文獻的參考書目及醫學會議的摘要,接觸試驗的作者取得進一步的資料及個別病人的數據。

選擇標準

研究:randomised controlled trials (RCTs) and quasirandomised trials (qRCTs). 研究:randomised controlled trials (RCTs) and quasirandomised trials (qRCTs) 。 參與者:有軀幹、腹部或多重創傷的病人接受腹部器官創傷的診斷性評估。 介入組:診斷流程包含緊急超音波檢查。控制組:診斷流程圖未包含緊急超音波檢查(例如,初步電腦斷層檢查[CT]或診斷性腹腔沖洗[DPL])。 結果評估:死亡率、使用電腦斷層檢查及診斷性腹腔沖洗、剖腹探查及陰性剖腹探查率、診斷延遲、以及生活品質。

資料收集與分析

由兩位作者獨立挑選含括的標準、評估方法的品質、及擷取資料。若可行,集結資料及relative risks (RRs)、risk differences (RDs) and weighted mean differences,個別的95% confidence intervals (CIs),均適當地依fixed or randomeffects modelling計算。

主要結論

我們發現有四篇文獻符合我們的含括標準。整體而言,這些研究都是中度方法學品質。少數研究的作者回應我們書面的尋求解決有爭議部分及取得個別病人資料的詢問。我們從三篇研究共集結包含1254個病人的死亡率資料relative risk偏向超音波那一側是1.00(95% CI 0.50至2.00)。超音波為基礎的路徑顯著降低電腦斷層數量(randomeffects RD −0.52, 95% CI −0.83 至 −0.21),但是此結果代表的意義並不清楚。基於超音波的低敏感性,電腦斷層數量的降低可能被認為是需要處理的數量或者是有損害的數量兩者之ㄧ。

作者結論

目前從RCTs並無足夠的證據來評斷推行超音波為基礎的臨床路徑來診斷疑似腹部頓傷的患者。

翻譯人

本摘要由高雄榮民總醫院王曉萍翻譯。

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。

總結

沒有證據贊成使用超音波來增加診斷腹部頓傷的患者。許多人因為腹部受頓傷(非穿刺傷)而入院,醫師在治療這些病人需要了解腹內的器官是否有受傷,超音波被認為有助於幫助診斷這些病人的狀況。在此回顧,作者尋求比較有使用超音波來幫助診斷與沒有使用超音波的腹部受傷的病人之死亡率,且尋求超音波的使用可以降低使用更複雜及昂貴的診斷方法之證據。然而,很少有這樣的研究,因此作者結論沒有足夠的的證據來評斷使用超音波為腹部創傷的診斷的一部份。