An algorithm to reduce the incidence of false-negative FAST∗∗∗Focused Assessment for the Sonographic Examination of the Trauma patient. examinations in patients at high risk for occult injury11No competing interests declared.

Ballard, Richard W.; Rozycki, Grace S.; Newman, Paul G.; Cubillos, Javier; Salomone, Jeffrey P.; Ingram, Walter L.; Feliciano, David V.

doi:10.1016/s1072-7515(99)00121-0

Cited by 108 publications

(16 citation statements)

References 32 publications

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“…Sixty percent of patients with initial FAST negative results still undergo abdominal exploration for injuries such as diaphragmatic injury or high suspicious of hallow viscus organ injury when no fluid is detected on FAST. This finding was reported by Ballard et al who found that even with initial negative FAST results in major pelvic fractures, patients required further investigations, because 31% required abdominal exploration later [ 18 ]. These occult injuries were diagnosed by CT scan, and 4/13 were false negative patients who required abdominal exploration because of grade IV liver injuries, bladder perforations, and diaphragmatic ruptures.…”

Section: Discussionsupporting

confidence: 56%

FAST accuracy in major pelvic fractures for decision-making of abdominal exploration: Systematic review and meta-analysis

Chaijareenont

Krutsri

Sumpritpradit

et al. 2020

Annals of Medicine and Surgery

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Background Major pelvic fractures are often associated with intra-abdominal organ injuries. Considering patients’ hemodynamic status, Focused Assessment with Sonography for Trauma (FAST) can facilitate decision-making for abdominal exploration. Non-therapeutic exploratory laparotomy from pelvic fractures should be avoided. Aim of this study is to determine the accuracy of FAST in diagnosing significant intraabdominal hemorrhage that leads to determine whether or not to pursue therapeutic abdominal exploration in patients with major pelvic fractures. Material and methods We systematically reviewed the PubMed and SCOPUS databases from 2009 to 2019 and also using a retrospective review of patients admitted to the Acute Care Surgery service from 2016 to 2019. We performed a meta-analysis by using a random effects model. Results A total 677 patients were analyzed, 28 cases from our hospital. Mean patient age was 40.8 years. Leading mechanism of injury were motor vehicle collision (44.72%), fall from height (13.41%), and motorcycle collision (13.69%). Average injury severity score (ISS) was 32.5 (range: 24.1–50), and overall mortality rate was 11.65%. The pooled sensitivity, specificity, and accuracy of FAST to identify significant intra-abdominal hemorrhage was 79%,90%, and 93%, respectively (95% confidence interval: 89%–94%). Meta-regression revealed no significant correlation between injury severity score and the accuracy of FAST. Conclusion Our meta-analysis revealed that FAST in major pelvic fracture accurately detected significant intra-abdominal hemorrhage. Using FAST in the presence of unstable hemodynamics, we can decide to perform abdominal exploration with the expectation of finding significant intra-abdominal hemorrhage require surgically control.

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Section: Discussionsupporting

confidence: 56%

FAST accuracy in major pelvic fractures for decision-making of abdominal exploration: Systematic review and meta-analysis

Chaijareenont

Krutsri

Sumpritpradit

et al. 2020

Annals of Medicine and Surgery

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“…Third, there is also a selection bias about the sensitivity and specificity of FAST. FAST has been shown to be an accurate diagnostic test in the setting of pelvic fractures, detecting hemoperitoneum with a specificity of 87% to 100% and sensitivity of 75% to 81% [1,5,23]. Finally, the trauma registry suffers from a number of missing data, especially unknown hospital discharge disposition.…”

Section: Discussionmentioning

confidence: 99%

Comparison between laparotomy first versus angiographic embolization first in patients with pelvic fracture and hemoperitoneum: a nationwide observational study from the Japan Trauma Data Bank

Katsura

Yamazaki

Fukuma

et al. 2013

Scand J Trauma Resusc Emerg Med

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BackgroundA common dilemma in the management of pelvic fractures is recognizing the presence of associated abdominal injury. The purpose of this study was to determine the association between initial therapeutic intervention (laparotomy or transcatheter arterial embolization (TAE)) and mortality.MethodsThis was a cohort study using the Japan Trauma Data Bank between 2004 and 2010, including blunt trauma patients with pelvic fractures and positive Focused Assessment with Sonography in Trauma (FAST) results. Eligible patients were restricted to those who underwent laparotomy or TAE/angiography as the initial therapeutic intervention. Crude and adjusted odds ratio (AOR) for in-hospital mortality were compared between the laparotomy first and TAE first groups (reference group). Multiple logistic regression analysis and propensity score adjusted analysis were used to adjust for clinically relevant confounders, including the severity of injury.ResultsOf the 317 participants, 123 patients underwent laparotomy first and 194 patients underwent TAE first. The two groups were similar in terms of age, although the laparotomy first group had higher mean Injury Severity Scores (ISS) and higher mean scores based on the abdominal Abbreviated Injury Scale (AIS), as well as lower mean pelvic AIS and systolic blood pressure (SBP). Half of the patients who were hypotensive (SBP < 90 mmHg) on arrival underwent TAE first. The laparotomy first group had a significantly higher crude in-hospital mortality (41% vs. 27%; P < 0.01). After adjusting for confounders, the choice of initial therapeutic intervention did not affect the in-hospital mortality (AOR, 1.20; 95% Confidence Interval (CI), 0.61-2.39). Even in the limited subgroup of hypotensive patients (SBP 66–89 mmHg and SBP < 65 mmHg subgroup), the effect was similar (AOR, 1.50; 95% CI, 0.56-4.05 and AOR, 1.05; 95% CI, 0.44-3.03).ConclusionsIn Japan, laparotomy and TAE are equally chosen as the initial therapeutic intervention regardless of hemodynamic status. No significant difference was seen between the laparotomy first and TAE first groups regarding in-hospital mortality.

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“… 19 Development of hemoperitoneum over time, those some limitation of the study qualities can make it difficult to detect injuries with slower bleeding at US, so timing may be more responsible for the discrepancy in this patient than imaging modality because of ongoing bleeding and active fluid resuscitation in the interval between FAST and follow up ultrasound after two hours. 20 …”

Section: Discussionmentioning

confidence: 99%

Predictive value of focused assessment with sonography for trauma (FAST) for laparotomy in unstable polytrauma Egyptians patients

Elbaih

Abu-Elela

2017

Chinese Journal of Traumatology

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PurposeThe emergency physicians face significant clinical uncertainty when multiple trauma patients arrive in the emergency department (ED). The priorities for assessment and treatment of polytrauma patients are established in the primary survey. Focused assessment with sonography for trauma (FAST) is very essential clinical skill during trauma resuscitation. Use of point of care ultrasound among the trauma team working in the primary survey in emergency care settings is lacking in Suez Canal University Hospitals even ultrasound machine not available in ED. This study aims to evaluate the accuracy of FAST in hemodynamically unstable polytraumatized patients and to determine its role as an indication of laparotomy.MethodsThis study is a cross-sectional study included 150 polytrauma patients with a blunt mechanism admitted in Suez Canal University Hospital. Firstly primary survey by airway check, cervical spine securing with neck collar, maintenance of breathing/circulation and management of life threading conditions if present were conducted accordingly to ATLS (advanced trauma life support) guidelines. The patients were assessed in the primary survey using the FAST as a tool to determine the presence of intra-abdominal collection.ResultsA total of 150 patients, and FAST scans were performed in all cases. The sensitivity and specificity were 92.6% and 100%, respectively. The negative predictive value was 92%, while the positive predictive value of FAST was 100%. The accuracy of FAST was 96%.ConclusionFAST is an important method to detect intra-abdominal fluid in the initial assessment in hemodynamically unstable polytrauma patients with high accuracy.

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An algorithm to reduce the incidence of false-negative FAST∗∗∗Focused Assessment for the Sonographic Examination of the Trauma patient. examinations in patients at high risk for occult injury11No competing interests declared.

Cited by 108 publications

References 32 publications

FAST accuracy in major pelvic fractures for decision-making of abdominal exploration: Systematic review and meta-analysis

FAST accuracy in major pelvic fractures for decision-making of abdominal exploration: Systematic review and meta-analysis

Comparison between laparotomy first versus angiographic embolization first in patients with pelvic fracture and hemoperitoneum: a nationwide observational study from the Japan Trauma Data Bank

Predictive value of focused assessment with sonography for trauma (FAST) for laparotomy in unstable polytrauma Egyptians patients

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