PURPOSE: To validate abdominal ultrasonography and helical computed tomography in detecting causes for sepsis in patients after abdominal surgery and to determine improved criteria for its use. MATERIALS AND METHODS: Eighty-five consecutive surgical patients primarily operated for non-infectious disease were included in this prospective study. Forty-one patients were admitted to the intensive care unit. All patients were suspected of an intra-abdominal sepsis after abdominal surgery. Both ultrasonography (US) and helical abdominal computed tomography (CT) were performed to investigate the origin of an intra-abdominal sepsis. The images of both US and CT were interpreted on a four-point scale by different radiologists or residents in radiology, the investigators were blinded of each other's test. Interpretations of US and CT were compared with a reference standard which was defined by the result of diagnostic aspiration of suspected fluid collections, (re)laparotomy, clinical course or the opinion of an independent panel. Likelihood ratios and post-test probabilities were calculated and interobserver agreement was determined using kappa statistics. RESULTS: The overall prevalence of an abdominal infection was 0.49. The likelihood ratio (LR) of a positive test-result for US was 1.33 (95% CI: 0.8-2.5) and for CT scan 2.53 (95% CI: 1.4-5.0); corresponding post-test probabilities for US 0.57 (95% CI: 0.42-0.70) and for CT 0.71 (95% CI: 0.57-0.83). The LR of a negative test-result was, respectively, 0.60 (95% CI: 0.3-1.3) and 0.18 (95% CI: 0.06-0.5); corresponding post-test probabilities for US 0.37 (95% CI: 0.20-0.57) and for CT 0.15 (95% CI: 0.06-0.32) were calculated. CONCLUSION: Computed tomography can be used as the imaging modality of choice in patients suspected of intra-abdominal sepsis after abdominal surgery. Because of the low discriminatory power ultrasonography should not be performed as initial diagnostic test.
PURPOSE: To validate abdominal ultrasonography and helical computed tomography in detecting causes for sepsis in patients after abdominal surgery and to determine improved criteria for its use. MATERIALS AND METHODS: Eighty-five consecutive surgical patients primarily operated for non-infectious disease were included in this prospective study. Forty-one patients were admitted to the intensive care unit. All patients were suspected of an intra-abdominal sepsis after abdominal surgery. Both ultrasonography (US) and helical abdominal computed tomography (CT) were performed to investigate the origin of an intra-abdominal sepsis. The images of both US and CT were interpreted on a four-point scale by different radiologists or residents in radiology, the investigators were blinded of each other's test. Interpretations of US and CT were compared with a reference standard which was defined by the result of diagnostic aspiration of suspected fluid collections, (re)laparotomy, clinical course or the opinion of an independent panel. Likelihood ratios and post-test probabilities were calculated and interobserver agreement was determined using kappa statistics. RESULTS: The overall prevalence of an abdominal infection was 0.49. The likelihood ratio (LR) of a positive test-result for US was 1.33 (95% CI: 0.8-2.5) and for CT scan 2.53 (95% CI: 1.4-5.0); corresponding post-test probabilities for US 0.57 (95% CI: 0.42-0.70) and for CT 0.71 (95% CI: 0.57-0.83). The LR of a negative test-result was, respectively, 0.60 (95% CI: 0.3-1.3) and 0.18 (95% CI: 0.06-0.5); corresponding post-test probabilities for US 0.37 (95% CI: 0.20-0.57) and for CT 0.15 (95% CI: 0.06-0.32) were calculated. CONCLUSION: Computed tomography can be used as the imaging modality of choice in patients suspected of intra-abdominal sepsis after abdominal surgery. Because of the low discriminatory power ultrasonography should not be performed as initial diagnostic test.
Authors: Doris Schacherer; Frank Klebl; Daniela Goetz; Roland Buettner; Stephanie Zierhut; Juergen Schoelmerich; Julia Langgartner Journal: Intensive Care Med Date: 2007-03-16 Impact factor: 17.440
Authors: Massimo Sartelli; Federico Coccolini; Yoram Kluger; Ervis Agastra; Fikri M Abu-Zidan; Ashraf El Sayed Abbas; Luca Ansaloni; Abdulrashid Kayode Adesunkanmi; Boyko Atanasov; Goran Augustin; Miklosh Bala; Oussama Baraket; Suman Baral; Walter L Biffl; Marja A Boermeester; Marco Ceresoli; Elisabetta Cerutti; Osvaldo Chiara; Enrico Cicuttin; Massimo Chiarugi; Raul Coimbra; Elif Colak; Daniela Corsi; Francesco Cortese; Yunfeng Cui; Dimitris Damaskos; Nicola De' Angelis; Samir Delibegovic; Zaza Demetrashvili; Belinda De Simone; Stijn W de Jonge; Sameer Dhingra; Stefano Di Bella; Francesco Di Marzo; Salomone Di Saverio; Agron Dogjani; Therese M Duane; Mushira Abdulaziz Enani; Paola Fugazzola; Joseph M Galante; Mahir Gachabayov; Wagih Ghnnam; George Gkiokas; Carlos Augusto Gomes; Ewen A Griffiths; Timothy C Hardcastle; Andreas Hecker; Torsten Herzog; Syed Mohammad Umar Kabir; Aleksandar Karamarkovic; Vladimir Khokha; Peter K Kim; Jae Il Kim; Andrew W Kirkpatrick; Victor Kong; Renol M Koshy; Igor A Kryvoruchko; Kenji Inaba; Arda Isik; Katia Iskandar; Rao Ivatury; Francesco M Labricciosa; Yeong Yeh Lee; Ari Leppäniemi; Andrey Litvin; Davide Luppi; Gustavo M Machain; Ronald V Maier; Athanasios Marinis; Cristina Marmorale; Sanjay Marwah; Cristian Mesina; Ernest E Moore; Frederick A Moore; Ionut Negoi; Iyiade Olaoye; Carlos A Ordoñez; Mouaqit Ouadii; Andrew B Peitzman; Gennaro Perrone; Manos Pikoulis; Tadeja Pintar; Giuseppe Pipitone; Mauro Podda; Kemal Raşa; Julival Ribeiro; Gabriel Rodrigues; Ines Rubio-Perez; Ibrahima Sall; Norio Sato; Robert G Sawyer; Helmut Segovia Lohse; Gabriele Sganga; Vishal G Shelat; Ian Stephens; Michael Sugrue; Antonio Tarasconi; Joel Noutakdie Tochie; Matti Tolonen; Gia Tomadze; Jan Ulrych; Andras Vereczkei; Bruno Viaggi; Chiara Gurioli; Claudio Casella; Leonardo Pagani; Gian Luca Baiocchi; Fausto Catena Journal: World J Emerg Surg Date: 2021-09-25 Impact factor: 5.469
Authors: Oddeke van Ruler; Jordy J S Kiewiet; Kimberley R Boer; Bas Lamme; Dirk J Gouma; Marja A Boermeester; Johannes B Reitsma Journal: BMC Surg Date: 2011-12-23 Impact factor: 2.102