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May 1994

Diagnostic Accuracy of Peritoneal Lavage in Patients With Pelvic Fractures

Author Affiliations

From the Department of Surgery, University of Washington School of Medicine, Seattle (Dr Mendez), Department of Surgery, Naval Hospital, San Diego, Calif (Dr Gubler), and Harborview Injury Prevention and Research Center, Seattle (Dr Maier).

Arch Surg. 1994;129(5):477-482. doi:10.1001/archsurg.1994.01420290023003

Objective:  To determine the accuracy of diagnostic peritoneal lavage (DPL) for the evaluation of intraabdominal injury in patients with a pelvic fracture as a result of blunt trauma.

Design:  Retrospective cohort analysis.

Setting:  Level I trauma center in metropolitan Seattle, Wash.

Patients:  Four hundred ninety-seven consecutive patients admitted with pelvic fractures following blunt trauma during a 60-month period.

Outcome Measures:  Positive results of DPL, defined by one of the following: an immediate aspiration of more than 10 mL of gross blood; a red blood cell count of more than 0.0001 × 1012/L; a white blood cell count greater than 0.0005 × 109/L; an elevated amylase, bilirubin, or creatinine level; or organic particles or bacteria in the effluent returned after installation of 1 L of crystalloid fluid lavaged in the peritoneal cavity.

Results:  Two hundred eighty-six patients underwent DPL. For 80 patients (28.0%), results of DPL were positive and for 194 patients (67.8%) the results of DPL were negative. For two patients (0.7%), results of DPL were false positive for a sensitivity of 94%. For another two patients (0.7%), the results of DPL were false negative for a specificity of 99%. As a diagnostic modality, DPL has a positive predictive value of 98% and a negative predictive value of 97%.

Conclusions:  Diagnostic peritoneal lavage is a reliable method for the evaluation of intra-abdominal injury and should remain a standard component in the evaluation of patients following blunt injury with or without pelvic fractures.(Arch Surg. 1994;129:477-482)