Sonographic scoring for operating room triage in trauma; accuracy for therapeutic laparotomy among blunt abdominal trauma patients in Mulago Hospital.

Abstract

Background: Trauma burden globally accounts for high levels of mortality and morbidity mainly associated with diagnostic and treatment delays of Blunt Abdominal Trauma (BAT). Patient’s evaluation for BAT remains a diagnostic challenge for emergency physicians and trauma surgeons world over. Focused Assessment with Sonography for Trauma (FAST) has emerged and been embraced as a rapid, noninvasive, and accurate method of evaluating BAT. SSORTT Score (sum of Ultrasound score, Systolic Blood Pressure and Pulse rate) gives a score that can predict therapeutic laparotomy among BAT patients. Although FAST has been widely accepted and adopted as an adjunct to the initial assessment of trauma patients with suspected BAT, Mulago Hospital is yet to implement the routine use of FAST. Objective: To assess the accuracy of SSORTT score for a therapeutic laparotomy by determining the sensitivity, specificity, predictive value. Study methodology: A prospective observational study was carried out at the A&E Unit, Mulago hospital from December 2012 to April 2013 conducted by convenient sampling. Eligible patients with BAT were evaluated for presence of hemoperitoneum using SonoSite TITAN® portable ultrasound machine 3.5-5MHz, as well as grade 3 shock (SBP<90mmHg and PR>120bpm).Further evaluation of patients with standard of care (SOC) to determine definitive management .The diagnostic accuracy of SSORTT score in predicting therapeutic laparotomy was determined by follow up of patients for three days and comparing day three outcome with SSORTT score at different cutoffs and SOC. Results: In total 195 patients were evaluated the male: female ratio was 6:1.The age group between 20-40 years comprised the majority of patients 153(79%). The commonest injury patterns were head injury 80(42%), followed by abdominal injuries at 54 (28%). SSORTT score cutoff ≤`1 i.e. SSORTT score >2 appropriately identified 19 of 21 patients that had laparotomy, with sensitivity = 90% Specificity = 90%, PPV =53% and NPV= 99%.Five patients of 23 who had laparotomy died due to anesthesia and trauma related complications . Conclusion: SSORTT score is a reliable tool for predicting the need for therapeutic laparotomy, with SSORTT >2 being more predictive than SSORTT scores <1.