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Wed Apr 22 17:04:32 BST 2009

Please do not confuse principles with preferences. 

I like DPL and use it but others may not. this does not mean that I am wrong and that they are right or visa versa.  DPL is a test like all tests. It has its good points and bad. The good is that it is very accurate (~98% ). the bad is that it is very accurate (~98%). It is so accurate in identifying the presence of blood it is overly sensitive. If it is followed closely many patients with a small amount of blood will get an operation that is not needed because the hemorrhage has stopped. The is true of the latest generation of CT. Many radiologists will identify things on the scan that do not require surgery. All of these tests require clinical judgment. They CANNOT be used in isolation of other physical examination and laboratory findings.

You should use the one the works best for YOU.

the eye scan - looking at the patient, and
the finger scan. - physical examination with the fingers
are both still a very important part of patient assessment.

Principle. determine what is going on in the abdomen
Preferences: 
Situation - where are you and the patient
Condition - what is the current condition of the patient acute?, in shock? just needs to R/O intraabdominal injury. What does the physical examination show?
Skill and experience. what the experience in your hospital with the various tests? Example what is your %  accuracy with FAST. Not how good in Dr Rozychi in Grady Hospital but how good are the sonographies in YOUR hospital
Resources - what tests does your hospital have quickly available DPL? FAST? CT?

Norman

Norman McSwain MD
Trauma Director, Charity Hospital
Professor of Surgery, Tulane University
New Orleans LA
504 988 5111
norman.mcswain at tulane.edu <mailto:norman.mcswain at tulane.edu> 

________________________________

From: trauma-list-bounces at trauma.org on behalf of Bevan Lowe
Sent: Wed 4/22/2009 1:47 AM
To: trauma-list at trauma.org
Subject: The role of DPA in 2009 and beyond

Is there any role of Diagnostic Peritoneal tap (DPA) or for that matter DPL in the ED in the hypotensive blunt trauma pt when we have FAST available these days?
Our approach is:- do a FAST, +ve OT, -ve repeat & look for other cause, if still ? abdo bleed go to OT. Equivocal FAST go to OT. Some surgeons are advocating DPA. Thoughts?

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The role of DPA in 2009 and beyond