Accuracy of FAST scan in blunt abdominal trauma in a major London trauma centre

Fleming, Simon; Bird, Ruth; Ratnasingham, Kumaran; Sarker, Shah-Jalal; Walsh, Mike; Patel, B.

doi:10.1016/j.ijsu.2012.05.011

Cited by 50 publications

(39 citation statements)

References 23 publications

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“…In our study, initial CT scan revealed blush in 19 cases with a low rate of failed NOM (0.5%). However, patients with negative FAST had increased risk of missed intra-abdominal injuries due to the lower specificity of the test [20]. In the present study, 65% of BSI cases had negative or inconclusive FAST results, and were diagnosed mainly upon CT scan evaluation.…”

Section: Discussionmentioning

confidence: 63%

Clinical and Radiological Presentations and Management of Blunt Splenic Trauma: A Single Tertiary Hospital Experience

et al. 2017

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BackgroundSplenic injury is the leading cause of major bleeding after blunt abdominal trauma. We examined the clinical and radiological presentations, management, and outcome of blunt splenic injuries (BSI) in our institution.Material/MethodsA retrospective study of BSI patients between 2011 and 2014 was conducted. We analyzed and compared management and outcome of different splenic injury grades in trauma patients.ResultsA total of 191 BSI patients were identified with a mean (SD) age of 26.9 years (13.1); 164 (85.9%) were males. Traffic-related accident was the main mechanism of injury. Splenic contusion and hematoma (77.2%) was the most frequent finding on initial computerized tomography (CT) scans, followed by shattered spleen (11.1%), blush (11.1%), and devascularization (0.6%). Repeated CT scan revealed 3 patients with pseudoaneurysm who underwent angioembolization. Nearly a quarter of patients were managed surgically. Non-operative management failed in 1 patient who underwent splenectomy. Patients with grade V injury presented with higher mean ISS and abdominal AIS, required frequent blood transfusion, and were more likely to be FAST-positive (p=0.001). The majority of low-grade (I–III) splenic injuries were treated conservatively, while patients with high-grade (IV and V) BSI frequently required splenectomy (p=0.001). Adults were more likely to have grade I, II, and V BSI, blood transfusion, and prolonged ICU stay as compared to pediatric BSI patients. The overall mortality rate was 7.9%, which is mainly association with traumatic brain injury and hemorrhagic shock; half of the deaths occurred within the first day after injury.ConclusionsMost BSI patients had grade I–III injuries that were successfully treated non-operatively, with a low failure rate. The severity of injury and presence of associated lesions should be carefully considered in developing the management plan. Thorough clinical assessment and CT scan evaluation are crucial for appropriate management of BSI.

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Section: Discussionmentioning

confidence: 63%

Clinical and Radiological Presentations and Management of Blunt Splenic Trauma: A Single Tertiary Hospital Experience

et al. 2017

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“…First, the interpretation of FAST positivity is user dependent(16–18) and both the ABC score and the original MTS have FAST as a variable. Therefore, the inclusion of it in a scoring system will result in prediction that reflects the differences in FAST sensitivity and specificity at individual institutions.…”

Section: Discussionmentioning

confidence: 99%

The Massive Transfusion Score as a decision aid for resuscitation

Callcut

Cripps

Nelson

et al. 2016

Journal of Trauma and Acute Care Surgery

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Introduction Prior work proposed a massive transfusion score [MTS] calculated from values obtained in the emergency department to predict likelihood of MT (massive transfusion). We hypothesized the MTS could be utilized at hour 6 to differentiate who continues to require balanced resuscitation in hour 7–24 and to predict death at 28 days. Methods We prospectively enrolled patients in whom the MT protocol (MTP) was initiated from 2005 to 2011. Data including timing of blood products were determined at hour 0, 6, 12, and 24. For each patient, transfusion needs were defined based upon either an inappropriately low hemoglobin response to transfusion or a hemoglobin decrease of > 1gm/dL if no transfusion. Timing and cause of death were utilized to account for survivor bias. Multivariate logistic regression was utilized to determine independent predictors of outcome. Results 190 MTP activations were included and by hour 6, 61% required >=10 units of PRBCs. Calculated at initial presentation, a Revised MTS (SBP<90mmHg, BD>=−6, Temp<35.5 C, INR>1.5, Hgb <11g/dL) was superior to the original MTS (including HR>=120bpm, FAST status, mechanism) or the ABC score for predicting MT (AUC MT at 6 hours 0.68, 95% CI 0.57–0.79; at 24 hour 0.72, 0.61–0.83; p<0.05); p<0.05). For those alive at hour 6, the Revised MTS was predictive of future PRBC need (AUC 0.87) in hour 7 to 12, 24-hour mortality (AUC 0.95), and 28-day mortality (AUC 0.77). For each additional positive trigger of the MTS at hour 6, the odds of death at 24 hours and 28 days was substantially increased (24 hours OR 4.6, 95% CI 2.3–9.3; 28 days OR 2.2, 95% CI 1.5–3.2, p<0.0001). Conclusion Early end points of resuscitation adopted from the components of the Revised MTS are predictive of on-going transfusion. Failure to normalize these components by hour 6 portends a particularly poor prognosis.

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“…The FAST examination is one of the most common applications of POCUS, with one survey in developing countries reporting it as the second most common ultrasound application behind obstetrical use. [9] Accuracy and ease of training of FAST among physicians worldwide have been well documented, [10][11][12] with one Peruvian study reporting increased confidence in FAST scanning abilities in physicians after just 2.5 hours of ultrasound training. [13] While our overall image adequacy rate of 74% after two hours of training appears impressive, it is diffi cult to compare as other studies on POCUS applications among non-physicians are lacking.…”

Section: Discussionmentioning

confidence: 99%

Can an 8^th grade student learn point of care ultrasound?

Kwon¹,

Lahham

Fox

2019

World Journal of Emergency Medicine

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BACKGROUND: Point-of-care ultrasound has gained widespread use in developing countries due to decreased cost and improved telemedicine capabilities. Ultrasound training, specifi cally image acquisition skills, is occurring with more frequency in non-medical personnel with varying educational levels in these underdeveloped areas. This study evaluates if students without a high school education can be trained to acquire useful FAST images, and to determine if an 8 th grade student can teach peers these skills. METHODS:The 8 th grade students at a small middle school were divided into two groups. One group received training by a certified medical sonographer, while the other group received training by a peer 8 th grade student trainer who had previously received training by the sonographer. After training, each student was independently tested by scanning the four FAST locations. A blinded ultrasound expert evaluated these images and deemed each image adequate or inadequate for clinical use. RESULTS:Eighty video image clips were obtained. The overall image adequacy rate was 74%. The splenorenal window had the highest rate at 95%, followed by retrovesical at 90%, hepatorenal at 75%, and subxiphoid cardiac at 35%. The adequacy rate of the sonographer-trained group was 78%, while the adequacy rate of the student-trained group was 70%. The difference in image adequacy rate between the two groups was not signifi cant (P-value 0.459). CONCLUSION:The majority of 8 th graders obtained clinically adequate FAST images after minimal training. Additionally, the student-trained group performed as well as the sonographer-trained group.

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Accuracy of FAST scan in blunt abdominal trauma in a major London trauma centre

Cited by 50 publications

References 23 publications

Clinical and Radiological Presentations and Management of Blunt Splenic Trauma: A Single Tertiary Hospital Experience

Clinical and Radiological Presentations and Management of Blunt Splenic Trauma: A Single Tertiary Hospital Experience

The Massive Transfusion Score as a decision aid for resuscitation

Can an 8^th grade student learn point of care ultrasound?

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Accuracy of FAST scan in blunt abdominal trauma in a major London trauma centre

Cited by 50 publications

References 23 publications

Clinical and Radiological Presentations and Management of Blunt Splenic Trauma: A Single Tertiary Hospital Experience

Clinical and Radiological Presentations and Management of Blunt Splenic Trauma: A Single Tertiary Hospital Experience

The Massive Transfusion Score as a decision aid for resuscitation

Can an 8th grade student learn point of care ultrasound?

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Can an 8^th grade student learn point of care ultrasound?