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The diagnostic usefulness of peritoneal lavage in penetrating trauma: a prospective evaluation and comparison with blunt trauma.

In order to assess the relative utility and reliability of peritoneal lavage as an aid in the management of patients with penetrating trauma, 709 patients (353 penetrating; 356 blunt) with trauma to the lower chest and/or abdomen were evaluated prospectively during 23 consecutive months. There were 144 true-positive, 14 false-positive, 524 true-negative, and 27 false-negative lavages for an error rate of 5.8 per cent (41/709). Intra-abdominal injury was present in 27 per cent of 15 patients with shotgun injuries, 54 per cent of 141 patients with gunshot injuries, and 24 per cent of 197 patients with stab wounds. The sensitivity, specificity, and test value of peritoneal lavage in this series was high and comparable in both penetrating and blunt trauma during the initial diagnostic evaluation of the trauma patient. The error rates were comparable in penetrating and blunt trauma; however, false-positive lavages occurred more frequently in blunt trauma and false-negative lavages occurred more frequently in penetrating trauma (p = .0022). Peritoneal lavage can be extremely useful in the initial evaluation of penetrating trauma of all types.