| Diagnostic Tool | Strength | Weakness |
|---|---|---|
| Physical examination | Expeditious, safe, and inexpensive; potential for serial examination | Diagnosis of specific injury (e.g., diaphragm) |
| Diagnostic peritoneal lavage | Expeditious, safe, and inexpensive | Diagnosis of diaphragmatic injury, hollow viscus injury, retroperitoneal injury; can be oversensitive and nonspecific |
| Computed tomography | Evaluation of peritoneum and retroperitoneum | Diagnosis of diaphragmatic injury, hollow viscus injury |
| Staging of solid organ injury | Expensive; controversial need for contrast | |
| Ultrasonography | Expeditious, safe, and inexpensive; accurate for free peritoneal fluid | Diagnosis of diaphragmatic injury, hollow viscus injury, penetrating injury; good specificity but moderate sensitivity |
| Potential for serial examinations | Less accurate in the presence of large retroperitoneal hematomas | |
| Laparoscopy | Diagnosis of peritoneal penetration, diaphragmatic injury | Diagnosis of hollow viscus injury, retroperitoneal injury |
| Evaluation of bleeding or solid organ injury | Expensive | |
| Potential for therapy | ||
| Video-assisted thoracoscopic surgery | Evaluation of lung, diaphragm, mediastinum, chest wall, and pericardium; potential for treatment | Requires operating room; expensive Diagnosis of abdominal injuries |
Reprinted with permission from VillavicencioRT, AucarJA. Analysis of laparoscopy in trauma. J Am Coll Surg1999;189:11.