The Diagnostic value of intraabdominal pressure changes in trauma patients

SUMMARY Trauma is a health problem which affects primarly young age groups and leads to important economics losts. Approximately 10 % of all trauma deaths result from abdominal injury. Ultrasonography (USG), diagnostic peritoneal lavage (DPL), and computorized tomography are the most frequently used methods in diagnosing blunt abdominal trauma. These methods have been used for several years and their efficasies of diagnosing blunt abdominal trauma have been proved in many studies. Our study objective was to compare the intraabdominal pressure measurement with routinely using USG results in blunt abdominal trauma patients, and to determine as if the measurement of intraabdominal pressure is a reliable method in the clinical settings. In our study, we prospectively measured the intraabdominal pressure by using intravesical catheter of 20 blunt trauma patients age over 17 with suspected blunt abdominal injury presenting to Dokuz Eylül University Medical Faculty Hospital between November 10th, 1998 and January 29th, 1999. Patients with known ascites, intraabdominal malignancy, blood at external uretheral meatus and pregnancy were excluded. Fourteen patients (70%) were male, six patients (30%) were female. The mean age of the patients was 36.15± 13.89. Mechanisms of trauma were; 14 (70%) motor vehicle accident, 3 (15%) pedestrian accident and 3 (15%) fall from height. Mean Intraabdominal Pressure (MIAP) values were high in 10 patients and normal in 10 patients. Four patients had intraabdominal bleeding (IAB) and all of which had high MİAP values. For determining the intraabdominal bleeding in blunt abdominal trauma patients, USG had a sensitivity of 100%, specificity of 93.7%, a positive predictive value (PPV) of 80% and a negative predictive value (NPV) of %100 and MIAP had a sensitivity of 100%, specificity of 62.5%, a positive predictive value (PPV) of 40% and a negative predictive value (NPV) of %100. These data suggest that MIAP values do not represent false-negative results, but represent a considerable amounts of false-positive results. To determine the efficacy of the measurement of intraabdominal pressure in blunt abdominal trauma patients, further clinical and experimental studies should be done. 29