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

Chaijareenont, Chunlaches; Krutsri, Chonlada; Sumpritpradit, Preeda; Singhatas, Pongsasit; Thampongsa, Tharin; Lertsithichai, Panuwat; Choikrua, Pattawia; Poprom, Napaphat

doi:10.1016/j.amsu.2020.10.018

Cited by 9 publications

(4 citation statements)

References 21 publications

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“…It defined significant intraabdominal injury as an injury necessitating surgical intervention through abdominal exploration. The study concluded that the FAST accurately identified significant intraabdominal hemorrhage in patients with pelvic fractures [ 24 ]. Consequently, we concur with the authors that, in this patient population, the evaluation of the FAST should not focus on its ability to detect any free fluid, as a positive FAST is defined in accordance with the ATLS guidelines.…”

Section: Discussionmentioning

confidence: 99%

Accuracy of FAST in detecting intraabdominal bleeding in major trauma with pelvic and/or acetabular fractures: a retrospective cohort study

Jensen,

Possfelt-Møller,

Nielsen

et al. 2024

Eur J Orthop Surg Traumatol

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Purpose The Focused Assessment with Sonography for Trauma (FAST) is a tool to rapidly detect intraabdominal and intrapericardial fluid with point-of-care ultrasound. Previous studies have questioned the role of FAST in patients with pelvic fractures. The aim of the present study was to assess the accuracy of FAST to detect clinically significant intraabdominal hemorrhage in patients with pelvic fractures. Methods We included all consecutive patients with pelvic and/or acetabular fractures treated our Level 1 trauma center from 2009–2020. We registered patient and fracture characteristics, FAST investigations and CT descriptions, explorative laparotomy findings, and transfusion needs. We compared FAST to CT and laparotomy findings, and calculated true positive and negative findings, sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV). Results We included 389 patients. FAST had a sensitivity of 75%, a specificity of 98%, a PPV of 84%, and a NPV of 96% for clinically significant intraabdominal bleeding. Patients with retroperitoneal hematomas were at increased risk for laparotomy both because of True-negative FAST and False-positive FAST. Conclusion FAST is accurate to identify clinically significant intraabdominal blood in patients with severe pelvic fractures and should be a standard asset in these patients. Retroperitoneal hematomas challenge the FAST interpretation and thus the decision making when applying FAST in patients with pelvic fractures.

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Section: Discussionmentioning

confidence: 99%

Accuracy of FAST in detecting intraabdominal bleeding in major trauma with pelvic and/or acetabular fractures: a retrospective cohort study

Jensen,

Possfelt-Møller,

Nielsen

et al. 2024

Eur J Orthop Surg Traumatol

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“…The same follows for renal lesions and pelvic fractures, although intraperitoneal fluid can be detected in cases where there is clinically significant extraperitoneal bleeding. [ 7 , 25 ] Once FAST/e-FAST protocol is not intended to detect extraperitoneal bleeding, strictly speaking, isolated extraperitoneal injuries are not supposed to be considered false negatives per se ; however, it is important to remember this possibility. Clinical information such as hematuria and pelvic instability at physical examination should be taken into account to pursue further investigation in these scenarios.…”

Section: Discussionmentioning

confidence: 99%

Focused assessment with sonography for trauma (FAST)

Silva¹,

Jayanthi²,

Chammas³

2023

J Med Ultrasound

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The main cause of death in traumas is hypovolemic shock. Physical examination is limited to detect hemopericardium, hemoperitoneum, and hemopneumothorax. Computed tomography (CT) is the gold standard for traumatic injury evaluation. However, CT is not always available, is more expensive, and there are transportation issues, especially in hemodynamically unstable patients. In this scenario, a rapid, reproducible, portable, and noninvasive method such as ultrasound emerged, directed for detecting hemopericardium, hemoperitoneum, and hemopneumothorax, in a “point of care” modality, known as the focused assessment with sonography for trauma (FAST) protocol. With decades of experience, spread worldwide, and recommended by the most prestigious trauma care guidelines, FAST is a bedside ultrasound to be performed when accessing circulation issues of trauma patients. It is indicated to hemodynamically unstable patients with blunt abdominal trauma, with penetrating trauma of the thoracoabdominal transition (where there is doubt of penetrating the abdominal cavity) and for any patient with the cause of the instability unknown. There are four regions to be examined in the traditional FAST protocol: pericardium (to detect cardiac tamponade), right upper abdominal quadrant, left upper abdominal quadrant, and pelvis (to detect hemoperitoneum). The called extended FAST (e-FAST) protocol also searches the pleural spaces for hemothorax and pneumothorax. It is important to know the false positives and false negatives of the protocol, as well as its limitations. FAST/e-FAST protocol is designed to provide a simple “yes or no” answer regarding the presence of bleeding. It is not intended to quantify the bleeding nor evaluate organ lesions due to its limited accuracy for these purposes. Moreover, the amount of bleeding and/or the identification of organ lesions will not change patient’s management: Hemodynamically unstable patients with positive FAST must go to the operating room without delay. CT should be considered for hemodynamically stable patients.

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“…In the case of pelvic trauma, e-FAST has a low sensitivity in the evaluation of possible retroperitoneal hemorrhage [ 30 , 31 ]. However, it helps to determine potential symphyseal diastasis, showing a high correlation with computed tomography (CT) measurements [ 32 , 33 ].…”

Section: Imaging Evaluationmentioning

confidence: 99%

Imaging Review of Pelvic Ring Fractures and Its Complications in High-Energy Trauma

et al. 2022

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Pelvic ring fractures are common in high-energy blunt trauma, especially in traffic accidents. These types of injuries have a high rate of morbidity and mortality, due to the common instability of the fractures, and the associated intrapelvic vascular and visceral complications. Computed tomography (CT) is the gold standard technique in the evaluation of pelvic trauma because it can quickly and accurately identify pelvic ring fractures, intrapelvic active bleeding, and lesions of other body systems. To properly guide the multidisciplinary management of the polytrauma patient, a classification criterion is mandatory. In this review, we decided to focus on the Young and Burgess classification, because it combines the mechanism and the stability of the fractures, helping to accurately identify injuries and related complications.

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

Cited by 9 publications

References 21 publications

Accuracy of FAST in detecting intraabdominal bleeding in major trauma with pelvic and/or acetabular fractures: a retrospective cohort study

Accuracy of FAST in detecting intraabdominal bleeding in major trauma with pelvic and/or acetabular fractures: a retrospective cohort study

Focused assessment with sonography for trauma (FAST)

Imaging Review of Pelvic Ring Fractures and Its Complications in High-Energy Trauma

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