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Published in:

01-07-2014

The Utility of FAST for Initial Abdominal Screening of Major Pelvic Fracture Patients

Authors: Diederik O. F. Verbeek, IJsbrand A. J. Zijlstra, Christaan van der Leij, Kornelis J. Ponsen, Otto M. van Delden, J. Carel Goslings

Published in: World Journal of Surgery | Issue 7/2014

Background

Focused Assessment with Sonography for Trauma (FAST) is widely used in pelvic fracture patients. We examined the performance of FAST for detecting hemoperitoneum and predicting the need for intra-abdominal hemorrhage control in major pelvic fracture patients.

Methods

A 5-year retrospective study of major pelvic fracture patients was performed. The presence of hemoperitoneum was confirmed on CT or at laparotomy. The need for hemorrhage control was defined as requiring a surgical or radiological intervention for intra-abdominal bleeding. Hemorrhagic shock (HS) patients had a systolic blood pressure ≤90 mmHg or base deficit of ≥ 6 mEq/L on admission.

Results

A total of 120 patients were included, 42 (35 %) of which had any hemoperitoneum and 21 (18 %) had a moderate-large amount. The sensitivity, specificity, and positive and negative predictive values of FAST for any hemoperitoneum were 64, 94, 84, and 83 % and for a moderate-large amount they were 86, 86, 56, and 97 %. In HS patients the indices were 68, 93, 88, and 78 % for any hemoperitoneum and 79, 83, 65, and 91 % for a moderate-large amount. For the need for hemorrhage control, FAST had a positive predictive value of 50 % (16/32) in all and 71 % (12/17) in HS patients. The negative predictive value was 99 % (87/88) in all and 97 % (31/32) in HS patients.

Conclusion

FAST had a good to excellent diagnostic accuracy, depending on the size of hemoperitoneum. A positive FAST result (even in HS patients) does not reliably predict the need for immediate intra-abdominal hemorrhage control but a negative FAST result renders the need for an intervention highly unlikely.

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Title: The Utility of FAST for Initial Abdominal Screening of Major Pelvic Fracture Patients
Authors: Diederik O. F. Verbeek
IJsbrand A. J. Zijlstra
Christaan van der Leij
Kornelis J. Ponsen
Otto M. van Delden
J. Carel Goslings
Publication date: 01-07-2014
Publisher: Springer US
Published in: World Journal of Surgery / Issue 7/2014
Print ISSN: 0364-2313
Electronic ISSN: 1432-2323
DOI: https://doi.org/10.1007/s00268-013-2412-z

At a glance: The STEP trials

Springer Medicine

The Utility of FAST for Initial Abdominal Screening of Major Pelvic Fracture Patients

Background

Methods

Results

Conclusion

At a glance: The STEP trials

Springer Medicine

Background

Methods

Results

Conclusion

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