Diagnostic Peritoneal Lavage

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Abstract
A 5-year retrospective review of 3,503 diagnostic peritoneal lavage (DPL) patients was conducted, identifying 48 (13%) blunt trauma patients who had a DPL WBC count < 500/mm3. The mean DPL WBC count was 1,646 ± 2,275. Twenty (42%) of these patients were observed and discharged without subsequent operation or morbidity. Laparotomy was performed on 28 (58%) patients; 17 (61%) had a negative lap, 11 (39%) had intra-abdominal injuries requiring surgical repair or drainage (54% solid organ, 27% hollow viscus, 18% diaphragmatic). There were no significant differences between the three subgroups with regards to age, injury severity, time interval between injury and DPL, or mean DPL WBC count (p > 0.05). The negative-lap and no-lap groups had a significantly larger number of females; one presented with PID. The positive predictive value (PPV) of an isolated lavage WBC count of ≥ 500/ mm3 for intra-abdominal injury was 23% (11/48). The PPVs for DPLs performed < and ≥ 3 hours or those recalculated using WBC values higher than 500/mm3 were not significantly different. We conclude that: 1) the PPV of an isolated WBC count ≥ 500/mm3 in the DPL of a blunt trauma patient for injuries requiring surgical repair or drainage is 23% ± 14%; 2) increasing the DPL WBC count value for positivity did not significantly improve the PPV, nor did performing the DPL < or ≥ 3 hours postinjury; 3) solid/hollow viscus organs and diaphragmatic injuries can elevate DPL WBC counts ≥ 500/mm3, and 4) gynecologic processes can lead to false positive DPL WBC count elevations. These data suggest a rationale for discontinuing the use of an isolated WBC count > 500/mm3 as a criterion for mandatory laparotomy in blunt trauma patients, due to its low PPV for intra-abdominal injuries requiring surgical repair or drainage.