Diagnostic value of ultrasonography in evaluation of BLUNT abdominal trauma based on surgical findings at MTRH, Eldoret-Kenya.

Abstract

Background: Abdominal injuries rank third as a cause of traumatic death just after head and chest injuries. Rapid diagnosis and treatment is very vital. Evaluation of diagnostic value of ultrasonography is important to ascertain the reliability of ultrasound findings in blunt abdominal trauma in order to aid clinical decisions. Objective: To determine ultrasound test findings and ascertain the diagnostic value of ultrasonography in evaluation of blunt abdominal trauma as confirmed by surgical findings at Moi Teaching and Referral Hospital, Eldoret, Kenya. Methods: This was a cross -sectional study conducted at Moi Teaching and Referral Hospital between October 2016 and September 2017. A total of forty six patients who presented with blunt abdominal trauma and subjected to abdominal ultrasonography and subsequent surgery were enrolled. All the sonograms were performed by either the principal investigator or trained research assistant and images reviewed by two consultant radiologists. Ultrasound findings were documented and comparison done with surgical findings. Data was collected using structured questionnaire and analysis done using Stata/MP version 13 software. Categorical variables were summarized as frequencies and percentages while continuous variables as median and standard deviation. Association between categorical variables was assessed using Fisher exact test. A P-value of less than 0.05 was considered statistically significant. Results were presented using tables and charts. Results: The mean age of participants was 30.3 years (SD 14.2). The most common ultrasound findings in blunt abdominal trauma was hemoperitoneum at 91.3 % followed by splenic injury and liver injury at 13.04 % and 10.87 % respectively. 8.7 % of participants had normal ultrasound findings. Ultrasound had a high sensitivity in detection of hemoperitoneum at 91.98 % with a specificity of 77.78 % and an overall diagnostic accuracy of 89.13%. Sonographic features of hemoperitoneum was significantly associated with surgical findings of organ injury (p < 0.0001, Fisher Exact test). Ultrasound had a low sensitivity of 37.5% in detection of parenchymal injuries with specificity of 78.57 % and an overall accuracy of 50 %.There was no significant association between sonographic features and surgical findings in detection of parenchymal injuries (p-value = 0.3306,Fisher Exact test). Conclusion: Hemoperitoneum was the most common ultrasound finding in patients with blunt abdominal trauma. The diagnostic value of ultrasound was found to be high in the evaluation of hemoperitoneum with a sensitivity of 91.98% but low in evaluation of parenchymal injuries with a sensitivity of 37.5 %. Recommendations: Routine use of sonography for evaluation of blunt abdominal trauma as part of primary survey. Use of additional diagnostic adjuncts in evaluation of parenchymal injuries.