Can Ultrasound Replace Diagnostic Peritoneal Lavage in the Assessment of Blunt Trauma?

McKenney, Mark; Lentz, Kimberley; Nuñez, Diego; Sosa, Jorge; Sleeman, Danny; Axelrad, Alex; Martin, Ludmila Katherine; Kirton, Orlando C.; Oldham, C.

doi:10.1097/00005373-199409000-00018

Cited by 175 publications

(75 citation statements)

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“…[2,[15][16][17][18][19][20][21][22][23][24][25] The results of our study suggest that the accuracy of FAST performed by paramedics working in the ED, and trained in FAST, is comparable to non-radiologist-performed FAST. To our knowledge, this is the first study to assess the accuracy of FAST when performed by paramedics in the ED, trained in the performance and interpretation of FAST.…”

Section: Discussionmentioning

confidence: 78%

Paramedic Performed Focused Assesment with Sonography in Trauma (FAST) in the Emergency Department

Ünlüer¹,

Yavaşı²,

Kara³

et al. 2011

Ulus Travma Acil Cerrahi Derg

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AMAÇTravmayı takiben acil servise başvuran hastalarda paramediklerce uygulanan travmaya odaklanmış ultrasonografi değerlendirmesinin (PFAST) serbest sıvı saptamadaki doğ-ruluğu araştırıldı. GEREÇ VE YÖNTEMDört saatlik teorik ve dört saatlik uygulamalı eğitim sonrası, dört paramedik travma hastalarını ileriye dönük inceledi. Altın standardımız ultrasonografi ve karın bilgisayarlı tomografisinin (KBT) resmi radyolog raporlarıydı. PFAST'in duyarlılık, seçicilik, pozitif ve negatif olabilirlik oranları ve tanısal odds oranı hesaplandı ve ki-kare testi ile SPSS 15.0 kullanılarak analiz edildi. BULGULARYüz yirmi yedi hasta paramedikler tarafından değerlendi-rildi. On dört hastada karında serbest sıvı vardı. Bunlardan 11 tanesi radyoloji raporlarıyla ve KBT ile uyumlu iken (gerçek pozitifler), üç tanesi negatif geldi (yanlış pozitifler). Yüz on üç olguda PFAST serbest sıvı için negatif idi. Bunlardan 111 tanesinde serbest sıvı yokken (gerçek negatifler), iki tanesinde KBT ile tespit edildi (yanlış negatifler). Sırasıyla duyarlılık, seçicilik, pozitif ve negatif olabilirlik oranları ve tanısal odds oranı 84,62, 97,37, 32,15, 0,16 ve 203,50 idi. SONUÇÇalışmamız, hastane acil servislerinde paramediklerin yük-sek doğruluk oranıyla FAST uygulayabileceklerini göster-mektedir.

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Section: Discussionmentioning

confidence: 78%

Paramedic Performed Focused Assesment with Sonography in Trauma (FAST) in the Emergency Department

Ünlüer¹,

Yavaşı²,

Kara³

et al. 2011

Ulus Travma Acil Cerrahi Derg

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“…Sonography has been employed successfully in Europe and Asia as a primary diagnostic examination in blunt abdominal trauma for over 20 years (1)(2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12). Multiple prospective trials conducted in several major trauma centers in North America have attempted to define the role ofsonography in blunt abdominal trauma (13)(14)(15)(16)(17)(18). The assumption that most, if not all, clinically significant abdominal injuries are associated with free intraperitoneal fluid, representing hemoperitoneum, is the foundation for the use of sonography as a screening test for blunt abdominal trauma.…”

Section: Of Blunt Trauma Patients With Abdominal Visceral Injuries Domentioning

confidence: 99%

Visceral injury without hemoperitoneum: A limitation of screening abdominal sonography for trauma

Sherbourne

Shanmuganathan

Chiu

et al. 1997

Emergency Radiology

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“…[1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18] Technique varies widely among trauma centers. The examination may consist of a brief survey for fluid alone, or it may include assessment of organ parenchyma.…”

mentioning

confidence: 99%

Importance of evaluating organ parenchyma during screening abdominal ultrasonography after blunt trauma.

Brown

Casola

Sirlin

et al. 2001

J of Ultrasound Medicine

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Objective. To determine the benefit of screening ultrasonography for parenchymal abnormalities as well as free fluid during screening abdominal ultrasonography in patients with blunt trauma. Methods. A total of 2693 patients with blunt trauma who were triaged to a level 1 trauma center underwent screening abdominal ultrasonography in the resuscitation suite. Examinations were performed by experienced sonographers and included a screen for free intraperitoneal fluid and evaluation of the abdominal organ parenchyma and heart for traumatic injury. Screening ultrasonographic findings were reviewed and compared with findings from autopsy, laparotomy, diagnostic peritoneal lavage, computed tomography, repeated ultrasonography, cystography, and clinical outcome. Imaging studies of all patients with confirmed or suspected injuries were reviewed to identify those in whom parenchymal findings aided diagnosis. Results. One hundred seventy-two patients were found to have evidence of abdominal injury due to blunt trauma on the basis of clinical data, imaging, laparotomy, or autopsy. Forty-four of these patients had no sonographic evidence of hemoperitoneum at the time of initial ultrasonography. Screening ultrasonographic findings were positive for injury in 19 of 44 patients on the basis of parenchymal findings or small retroperitoneal collections of fluid thought to be indicative of trauma. In the remaining 25 patients, screening ultrasonography showed no abnormalities, and injuries were detected by repeated ultrasonography, subsequent computed tomography, or diagnostic peritoneal lavage performed for suspected occult injury on the basis of clinical parameters. In addition, 47 of 126 injured patients with sonographically detected free fluid had parenchymal findings that helped localize injury. Sixteen of those patients were taken to the operating room on the basis of clinical and sonographic findings without undergoing computed tomography. Conclusions. The inability to show injuries with no hemoperitoneum or with delayed hemoperitoneum has been shown to be a limitation of ultrasonography in patients with blunt trauma. In our series, 26% of all patients with documented injuries had no free fluid visible on screening ultrasonography. Attention to findings other than free fluid allowed detection in 43% of injured patients without sonographic evidence of hemoperitoneum.

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Can Ultrasound Replace Diagnostic Peritoneal Lavage in the Assessment of Blunt Trauma?

Cited by 175 publications

References 0 publications

Paramedic Performed Focused Assesment with Sonography in Trauma (FAST) in the Emergency Department

Paramedic Performed Focused Assesment with Sonography in Trauma (FAST) in the Emergency Department

Visceral injury without hemoperitoneum: A limitation of screening abdominal sonography for trauma

Importance of evaluating organ parenchyma during screening abdominal ultrasonography after blunt trauma.

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