Which of the following statements about diagnostic peritoneal lavage (DPL) is/are false?

A. DPL is the diagnostic procedure of choice for gunshot wounds to the abdomen with no obvious intra-abdominal injuries.

D. DPL has been entirely replaced by computed tomography as the diagnostic procedure of choice following blunt abdominal trauma.

DISCUSSION: DPL remains the most sensitive and specific indicator of intra-abdominal injury in the trauma patient. The accuracy rates for DPL in several large collective series reveal an overall sensitivity of 95%, specificity of 98% to 99%, and overall accuracy of 97%. As result, DPL remains the mainstay for diagnosis of intraperitoneal injury in the trauma patient; however, not every trauma patient requires DPL. In the awake, alert, and responsive patient with isolated abdominal injuries, the physical examination and history are very helpful in predicting the presence of significant injury. In the patient with lower torso (nipples to pubis) or back or flank gunshot wounds, the incidence of intra-abdominal injury is so high that exploratory laparotomy without further diagnostic modalities is generally advocated. In addition, DPL is generally inaccurate in the diagnosis of retroperitoneal injuries (duodenum, renal, pancreas), and significant retroperitoneal hemorrhage in association with pelvic fractures produces a false-positive DPL rate of up to 30%. Computed tomography (CT) scans have proved extremely valuable in these situations. General recommendations for the use of abdominal CT scans in trauma victims include patients who are hemodynamically stable (normal) with (1) equivocal abdominal examination, (2) closed head injury, (3) spinal cord injury, (4) hematuria, and (5) pelvic fractures with significant bleeding. These five indications are appropriate if the patient is truly hemodynamically stable and the time required to perform CT does not delay any surgical procedures.