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Contemporary utility of diagnostic peritoneal aspiration in trauma.
- Source :
-
The journal of trauma and acute care surgery [J Trauma Acute Care Surg] 2021 Nov 01; Vol. 91 (5), pp. 814-819. - Publication Year :
- 2021
-
Abstract
- Background: Focused Assessment with Sonography for Trauma (FAST) has supplanted diagnostic peritoneal lavage (DPL) as the preferred bedside evaluation for traumatic hemoperitoneum. Diagnostic peritoneal aspiration (DPA) is a simpler, faster modification of DPL with an unclear role in contemporary practice. This study delineated modern roles for DPA and defined its diagnostic yield.<br />Methods: All trauma patients presenting to our Level I center who underwent DPA were included (May 2015 to May 2020). Demographics, comorbidities, clinical/injury data, and outcomes were collected. The diagnostic yield and accuracy of DPA were calculated against the criterion standard of hemoperitoneum at exploratory laparotomy or computed tomography scan.<br />Results: In total, 41 patients underwent DPA, typically after blunt trauma (n = 37, 90%). Patients were almost exclusively hypotensive (n = 20, 49%) or in arrest (n = 18, 44%). Most patients had an equivocal or negative FAST and hypotension or return of spontaneous circulation after resuscitative thoracotomy (n = 32, 78%); or had a positive FAST and known cirrhosis (n = 4, 10%). In two (5%) patients, one obese, the catheter failed to access the peritoneal cavity. Diagnostic peritoneal aspiration sensitivity, specificity, positive predictive value, and negative predictive value were 80%, 100%, 100%, and 90%, with an accuracy of 93%. One (2%) complication, a small bowel injury, occurred.<br />Conclusion: Despite near ubiquitous FAST availability, DPA remains important in diagnosing or excluding hemoperitoneum with exceedingly low rates of failure and complications. Diagnostic peritoneal aspiration is most conclusive when positive, without false positives in this study. Diagnostic peritoneal aspiration was most used among blunt hypotensive or postarrest patients who had an equivocal or negative FAST, in whom the preliminary diagnosis of hemoperitoneum is a critically important decision making branch point.<br />Level of Evidence: Diagnostic, level III.<br /> (Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.)
- Subjects :
- Adult
Clinical Decision-Making methods
Feasibility Studies
Female
Hemoperitoneum epidemiology
Hemoperitoneum etiology
Humans
Male
Middle Aged
Predictive Value of Tests
Retrospective Studies
Tomography, X-Ray Computed
Focused Assessment with Sonography for Trauma statistics & numerical data
Hemoperitoneum diagnosis
Paracentesis statistics & numerical data
Peritoneal Lavage statistics & numerical data
Wounds, Nonpenetrating complications
Subjects
Details
- Language :
- English
- ISSN :
- 2163-0763
- Volume :
- 91
- Issue :
- 5
- Database :
- MEDLINE
- Journal :
- The journal of trauma and acute care surgery
- Publication Type :
- Academic Journal
- Accession number :
- 34108417
- Full Text :
- https://doi.org/10.1097/TA.0000000000003232