VALIDITY OF THE FAST SCAN FOR DIAGNOSIS OF INTRAABDOMINAL INJURY IN BLUNT ABDOMINAL TRAUMA

Yasmeen Iqbal, Muhammad Naeem Taj, Anis Ahmed, Zia Ur Rehman, Zakia Akbar

Abstract


Background: Blunt abdominal trauma is regularly encountered in the emergency department. The aim of the study is to determine the validity of assessment with sonography for trauma (FAST) scans in the evaluation of BAT in comparison to Computed tomogram/Exploratory laparotomy (CT/ELAP). Methods: This cross-sectional study was carried out at Ayub Teaching Hospital Abbottabad from January 2010 to December 2011. FAST was performed as part of the primary or secondary survey of the trauma patient in the emergency department in all patients with suspected blunt abdominal trauma. All of them also underwent either CT or ELAP depending on their clinical condition. The validity of FAST scan in comparison to CT/ELAP was documented. Results: Our study included 100 patients with suspected blunt abdominal trauma. The mean age was 31.52±16.79 years with 88% males. Road traffic accidents accounted for 80% cases and 20% were due to fall. Seventy percent were hemodynamically stable and 30% were unstable. Haemodynamically unstable patients had significantly more positive FAST scans and more positive CT/ELAP (p<0.05). Of the total, 52% had positive CT/ELAP and 54% had positive FAST scan. Majority (28%) had splenic injury. A positive scan had a statistically significant probability of a confirmed blunt abdominal trauma on CT/ELAP; p=0.00, OR=8.095, 95% CI=3.3–19.8. FAST scan had a sensitivity, specificity, positive predictive value and negative predictive value of 76.92%, 70.83%, 74.07% and 73.9% respectively. Conclusion: FAST scan had lesser accuracy as compared to previously published local and international data. More work is required before it can be routinely utilized to triage the blunt abdominal trauma patients to laparotomy.

Keywords: Blunt, abdominal trauma, laparotomy, FAST, scan

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References


Ghazanfar A, Choudry ZA, Zubair M, Nasir SM, Khan SA Ahmed W. Abdominal solid visceral injuries in blunt abdominal trauma - an experience in busy surgical unit of Mayo Hospital, Lahore. Ann King Edwards Med Coll 2001;7(2):85–7.

Enderson BL, Reath DB, Meadors J, Dallas W, DeBoo JM, Maull KI. The tertiary trauma survey: a prospective study of missed injury. J Trauma 1990;30:666–9.

Muizuddin M, Rehman A, Alam SN, Manzar S. Intra-abdominal visceral injuries in blunt abdominal trauma. Pak J Surg 2009;25:29–32.

Marx JA, Isenhour JL. Abdominal trauma. In: Marx, JA, Robert S, editors. Rosen’s Emergency Medicine Concepts and Clinical Practice. 6th ed. Philadelphia: Elsevier; 2006.

Poletti PA, Mirvis SE, Shanmuganathan K, Takada T, Killeen KL, Perlmutter D, et al. Blunt abdominal trauma patients: can organ injury be excluded without performing computed tomography? J Trauma 2004;57:1072–81.

Radwan MM, Abu Zidan FM. Focussed Assessment Sonograph Trauma (FAST) and CT scan in blunt abdominal trauma: surgeon's perspective. Afr Health Sci 2006;6:187–90.

Korner M, Krotz MM, Degenhart C, Pfeifer KJ, Reiser MF, Linsenmaier U. Current role of emergency US in patients with major trauma. Radiographics 2008;28:225–42.

Ollerton JE, Sugrue M;Balogh Z, D'Amours SK, Giles A, Wyllie P. Prospective study to evaluate the influence of FAST on trauma patient management. J Trauma 2006;60:785–91.

Christie-Large M, Michaelides D, James SLJ. Focused assessment with sonography for trauma: the FAST scan. Trauma 2008;2:93–101.

Lee BC, Ormsby EL, McGahan JP, Melendres GM, Richards JR. The utility of sonography for the triage of blunt abdominal trauma patients to exploratory laparotomy. Am J Roentgenol 2007;188:415–21.

Friese RS, Malekzadeh S, Shafi S, Gentilello LM, Starr A. Abdominal ultrasound is an unreliable modality for the detection of hemoperitoneum in patients with pelvic fracture. J Trauma 2007;63:97–102.

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.

Chaudhry R, Galagali A, Narayanan RV. Focused Abdominal Sonography in Trauma (FAST). Med J Armed Forces India 2007;63:62–3.

Melniker LA, McKinney MG, Liebner E, Briggs WM. Randomized clinical trial of point-of-care, limited ultrasonography for trauma in the emergency department: Sonography Outcomes Assessment Program (SOAP)-1 trial. Ann Emerg Med 2004;44(4):2.

Chambers JA, Pilbrow WJ. Ultrasound in abdominal trauma: an alternative to peritoneal lavage. Arch Emerg Med 1988;5:26–33.

Stengel D, Bauwens K, Sehouli J, Rademacher G, Mutze S, Ekkernkamp A, et al. Emergency ultrasound-based algorithms for diagnosing blunt abdominal trauma. Cochrane Database Syst Rev 2005;2:CD004446.

McKenney MG, Martin L, Lentz K, Lopez C, Sleeman D, Aristide G, et al. 1,000 consecutive ultrasounds for blunt abdominal trauma. J Trauma 1996;40:607–12.

Dolich MO, McKenney MG, Varela JE, Compton RP, McKenney KL, Cohn SM. 2,576 ultrasounds for blunt abdominal trauma. J Trauma 2001;50:108–12.

Rozycki GS, Ballard RB, Feliciano DV, Schmidt JA, Pennington SD. Surgeon-performed ultrasound for the assessment of truncal injuries: lessons learned from 1540 patients. Ann Surg 1998;228:557–67.

Baluch GMK. Diagnostic value of ultrasound in blunt abdominal trauma. J Surg Pak 2001;6(3):23–5.

Brooks A, Davies B, Smethhurst M, Connolly J. Prospective evaluation of non-radiologist performed emergency abdominal ultrasound for haemoperitoneum. Emerg Med J 2004;21(5):e5.

Geeraedts L, Kaasjager H, Van Vugt A, Frolke JP. Exsanguination in trauma: A review of diagnostics and treatment options. Injury 2009;40:11–20.

Bakker J, Genders R, Mali W, Leenen L. Sonography as the primary screening method in evaluating blunt abdominal trauma. J Clin Ultrasound 2005;33:155–63.

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;23:446–8.

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

McCarter FD, Luchette FA, Molloy M, Hurst JM, Davis K Jr, Johannigman JA, et al. Institutional and individual learning curves for focused abdominal ultrasound for trauma: cumulative sum analysis. Annals of Surgery 2000;231:689–700.


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