Routine abdominal ultrasonography and computed tomography in multiple trauma patients: relevance to therapy in 105 patients

Purpose: To examine treatment decisions in multiple trauma patients and determine how often these decisions are based on abdominal ultrasonography (US) findings, and how frequently these decisions are altered by subsequent computed tomographic (CT) imaging. Methods: From August 1996 to July 1997 we prospectively performed abdominal US followed by abdominal CT in all hemodynamically stable multiple trauma victims who did not need immediate surgery. We recorded the results from both modalities, as well as the treatment decisions based on these results. We also noted how frequently therapy based on US results was altered by the subsequent CT findings. Results: Treatment decisions were influenced by either US or CT in 27 of 105 patients (25.7 %). US was interpreted as normal in 76 patients (72.4 %), including 5 (6.6 %) who were subsequently found to have therapeutically significant findings on CT. US was interpreted as abnormal in 29 (27.6 %) patients, 12 of whom (41.4 %) had their management altered by subsequent CT results. Conclusions: Abdominal CT findings prompt changes in therapy in only a small number of stable multiple trauma patients who exhibit normal abdominal US. On the other hand, CT may have an impact on acute therapy in a large number of patients who exhibit abnormal US. Our results demonstrate that a diagnostic approach in hemodynamically stable patients is possible with US serving as a decision maker to determine whether further CT imaging is needed.