Top

Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine

Published in:

Open Access 01-12-2017 | Original research

Should we perform a FAST exam in haemodynamically stable patients presenting after blunt abdominal injury: a retrospective cohort study

Authors: D. Dammers, M. El Moumni, I.I. Hoogland, N. Veeger, E. ter Avest

Published in: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine | Issue 1/2017

Abstract

Background

Focussed Assessment with Sonography for Trauma (FAST) is a bedside ultrasonography technique used to detect free intraperitoneal fluid in patients presenting with blunt abdominal trauma (BAT) in the emergency department.

Methods

In this retrospective cohort study we investigated the potential of FAST as a risk stratification instrument in haemodynamically (HD) stable patients presenting after BAT by establishing the association between the FAST exam result and final outcome. An adverse outcome was defined in this context as the need for either a laparoscopy/laparotomy or an angiographic embolization or death due to abdominal injuries).

Results

A total of 421 patients with BAT were included, of which nine had an adverse outcome (2%). FAST was negative in 407 patients. Six of them turned out to have free intraperitoneal fluid (sensitivity 67 [41–86]%). FAST was positive in 14 patients, 12 of whom had free intraperitoneal fluid (specificity 99 [98–100]%). A positive FAST (positive likelihood ratio 34.3 [15.1–78.5]) was stronger associated with an adverse outcome than Injury Severity Score (ISS) or any individual clinical- or biochemical variables measured at presentation in the ED.

Discussion

The FAST exam can provide valuable prognostic information at minimal expenses during the early stages of resuscitation in haemodynamically stable patients presenting with BAT.

Conclusions

FAST exam should not be omitted in patients with BAT.

Available only for authorised users

Scalea TM, Rodriguez A, Chiu WC, Brenneman FD, Fallon Jr WF, Kato K, et al. Focused Assessment with Sonography for Trauma (FAST): results from an international consensus conference. J Trauma. 1999;46:466–72.CrossRefPubMed

Lentz KA, McKenney MG, Nunez Jr DB, Martin L. Evaluating blunt abdominal trauma:role for ultrasonography. J Ultrasound Med. 1996;15(6):447–51.PubMed

Holmes JF, Harris D, Battistella FD. Performance of abdominal ultrasonography in blunt trauma patients with out-of-hospital or emergency department hypotension. Ann Emerg Med. 2004;43:354–61.CrossRefPubMed

Wherrett LJ, Boulanger BR, McLellan BA, Brenneman FD, Rizoli SB, Culhane J, et al. Hypotension after blunt abdominal trauma: the role of emergent abdominal sonography in surgical triage. J Trauma. 1996;41:815–20.CrossRefPubMed

Stengel D, Rademacher G, Ekkernkamp A, Guthoff C, Mutze S. Emergency ultrasound-based algorithms for diagnosing blunt abdominal trauma. Cochrane Database Syst Rev. 2015;9:CD004446.

Griffin XL, Pullinger R. Are diagnostic peritoneal lavage or focused abdominal sonography for trauma safe screening investigations for hemodynamically stable patients after blunt abdominal trauma? A review of the literature. J Trauma. 2007;62:779–84.CrossRefPubMed

Kumar S, Bansal VK, Muduly DK, Sharma P, Misra MC, Chumber S, et al. Accuracy of Focused Assessment with Sonography for Trauma (FAST) in blunt trauma abdomen-a prospective study. Indian J Surg. 2015;77:393–97.CrossRefPubMed

Arhami Dolatabadi A, Amini A, Hatamabadi H, Mohammadi P, Faghihi-Kashani S, Derakhshanfar H, et al. Comparison of the accuracy and reproducibility of focused abdominal sonography for trauma performed by emergency medicine and radiology residents. Ultrasound Med Biol. 2014;40:1476–82.CrossRefPubMed

Ma OJ, Mateer JR, Ogata M, Kefer MP, Wittmann D, Aprahamian C. Prospective analysis of a rapid trauma ultrasound examination performed by emergency physicians. J Trauma. 1995;38:879–85.CrossRefPubMed

10.

Zamani M, Masoumi B, Esmailian M, Habibi A, Khazaei M, Mohammadi EM. A comparative analysis of diagnostic accuracy of focused assessment with sonography for trauma performed by emergency medicine and radiology residents. Iran Red Crescent Med J. 2015;17:e20302.CrossRefPubMedPubMedCentral

11.

Brenchley J, Walker A, Sloan JP, Hassan TB, Venables H. Evaluation of focussed assessment with sonography in trauma (FAST) by UK emergency physicians. Emerg Med J. 2006;23:446–48.CrossRefPubMedPubMedCentral

12.

Shojaee M, Faridaalaee G, Sabzghabaei A, Safari S, Mansoorifar H, Arhamidolatabadi A, et al. Sonographic detection of abdominal free fluid: emergency residents vs radiology residents. Trauma Mon. 2013;17:377–79.CrossRefPubMedPubMedCentral

13.

Tajoddini S, Shams VS. Ultrasonographic diagnosis of abdominal free fluid: accuracy comparison of emergency physicians and radiologists. Eur J Trauma Emerg Surg. 2013;39:9–13.CrossRefPubMed

14.

Melniker LA, Leibner E, McKenney MG, Lopez P, Briggs WM, Mancuso CA. Randomized controlled clinical trial of point-of-care, limited ultrasonography for trauma in the emergency department: the first sonography outcomes assessment program trial. Ann Emerg Med. 2006;48:227–35.CrossRefPubMed

15.

Boulanger BR, McLellan BA, Brenneman FD, Ochoa J, Kirkpatrick AW. Prospective evidence of the superiority of a sonography-based algorithm in the assessment of blunt abdominal injury. J Trauma. 1999;47:632–37.CrossRefPubMed

16.

Arrillaga A, Graham R, York JW, Miller RS. Increased efficiency and cost-effectiveness in the evaluation of the blunt abdominal trauma patient with the use of ultrasound. Am Surg. 1999;65:31–5.PubMed

17.

ATLS Subcommittee, American College of Surgeons’ Committee on Trauma, International ATLS working group. Advanced trauma life support (ATLS(R)): the ninth edition. J Trauma Acute Care Surg. 2013;74:1363–66.

18.

Hoff WS, Holevar M, Nagy KK, Patterson L, Young JS, Arrillaga A, et al. Practice management guidelines for the evaluation of blunt abdominal trauma: the East practice management guidelines work group. J Trauma. 2002;53:602–15.CrossRefPubMed

19.

Natarajan B, Gupta PK, Cemaj S, Sorensen M, Hatzoudis GI, Forse RA. FAST scan: is it worth doing in hemodynamically stable blunt trauma patients? Surgery. 2010;148:695–701.CrossRefPubMed

20.

Miller MT, Pasquale MD, Bromberg WJ, Wasser TE, Cox J. Not so FAST. J Trauma. 2003;54:52–60.CrossRefPubMed

21.

Moylan M, Newgard CD, Ma OJ, Sabbaj A, Rogers T, Douglass R. Association between a positive ED FAST examination and therapeutic laparotomy in normotensive blunt trauma patients. J Emerg Med. 2007;33:265–71.CrossRefPubMed

22.

Holmes JF, Brant WE, Bond WF, Sokolove PE, Kuppermann N. Emergency department ultrasonography in the evaluation of hypotensive and normotensive children with blunt abdominal trauma. J Pediatr Surg. 2001;36:968–73.CrossRefPubMed

23.

Menaker J, Blumberg S, Wisner DH, Dayan PS, Tunik M, Garcia M, et al. Use of the focused assessment with sonography for trauma (FAST) examination and its impact on abdominal computed tomography use in hemodynamically stable children with blunt torso trauma. J Trauma Acute Care Surg. 2014;77:427–32.CrossRefPubMed

24.

Bossuyt PM, Reitsma JB, Bruns DE, Gatsonis CA, Glasziou PP, Irwig L, et al. STARD 2015: an updated list of essential items for reporting diagnostic accuracy studies. BMJ. 2015;351:h5527.CrossRefPubMedPubMedCentral

25.

Laselle BT, Byyny RL, Haukoos JS, Krzyzaniak SM, Brooks J, Dalton TR, et al. False-negative FAST examination: associations with injury characteristics and patient outcomes. Ann Emerg Med. 2012;60:326–34.e3.CrossRefPubMed

26.

Stengel D, Bauwens K, Sehouli J, Porzsolt F, Rademacher G, Mutze S, et al. Systematic review and meta-analysis of emergency ultrasonography for blunt abdominal trauma. Br J Surg. 2001;88:901–12.CrossRefPubMed

27.

Deunk J, Brink M, Dekker HM, Kool DR, Blickman JG, van Vugt AB, et al. Predictors for the selection of patients for abdominal CT after blunt trauma: a proposal for a diagnostic algorithm. Ann Surg. 2010;251:512–20.CrossRefPubMed

28.

Rym Hamada S, Delhaye N, Kerever S, Harrois A, Duranteau J. Integrating eFAST in the initial management of stable trauma patients: the end of plain film radiography. Ann Intensive Care. 2016;6:62.CrossRef

Title: Should we perform a FAST exam in haemodynamically stable patients presenting after blunt abdominal injury: a retrospective cohort study
Authors: D. Dammers
M. El Moumni
I.I. Hoogland
N. Veeger
E. ter Avest
Publication date: 01-12-2017
Publisher: BioMed Central
Published in: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine / Issue 1/2017
Electronic ISSN: 1757-7241
DOI: https://doi.org/10.1186/s13049-016-0342-0

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Should we perform a FAST exam in haemodynamically stable patients presenting after blunt abdominal injury: a retrospective cohort study

Abstract

Background

Methods

Results

Discussion

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Discussion

Conclusions

Please log in to get access to this content

Other articles of this Issue 1/2017

The impact of early thromboelastography directed therapy in trauma resuscitation

The most commonly used disease severity scores are inappropriate for risk stratification of older emergency department sepsis patients: an observational multi-centre study

External validation of the ROSC after cardiac arrest (RACA) score in a physician staffed emergency medical service system

Trials and tribulations: how we established a major incident database

Poor performance of quick-SOFA (qSOFA) score in predicting severe sepsis and mortality – a prospective study of patients admitted with infection to the emergency department

Letter to the Editor regarding the article: "identifying pre-hospital factors associated with outcome for major trauma patients in a regional trauma network: an exploratory study"