Should we perform a FAST exam in haemodynamically stable patients presenting after blunt abdominal injury: a retrospective cohort study

Abstract

BackgroundFocussed Assessment with Sonography for Trauma (FAST) is a bedside ultrasonography technique used to detect free intraperitoneal fluid in patients presenting with blunt abdominal trauma (BAT) in the emergency department.MethodsIn this retrospective cohort study we investigated the potential of FAST as a risk stratification instrument in haemodynamically (HD) stable patients presenting after BAT by establishing the association between the FAST exam result and final outcome. An adverse outcome was defined in this context as the need for either a laparoscopy/laparotomy or an angiographic embolization or death due to abdominal injuries).ResultsA total of 421 patients with BAT were included, of which nine had an adverse outcome (2%). FAST was negative in 407 patients. Six of them turned out to have free intraperitoneal fluid (sensitivity 67 [41–86]%). FAST was positive in 14 patients, 12 of whom had free intraperitoneal fluid (specificity 99 [98–100]%). A positive FAST (positive likelihood ratio 34.3 [15.1–78.5]) was stronger associated with an adverse outcome than Injury Severity Score (ISS) or any individual clinical- or biochemical variables measured at presentation in the ED.DiscussionThe FAST exam can provide valuable prognostic information at minimal expenses during the early stages of resuscitation in haemodynamically stable patients presenting with BAT.ConclusionsFAST exam should not be omitted in patients with BAT.Electronic supplementary materialThe online version of this article (doi:10.1186/s13049-016-0342-0) contains supplementary material, which is available to authorized users.

Early computed tomography or focused assessment with sonography in abdominal trauma: what are the leading opinions?

“…While the specificity of FAST is consistently assessed between 98 and 99%, the reported sensitivity ranges from 22 to 78% depending on the study [20][21][22][23][24]. Regarding WBCT, its specificity is similar to that of FAST.…”

Focused assessment with sonography in trauma (FAST) for the regional anesthesiologist and pain specialist

“…In one retrospective study of 421 patients, the FAST exam was evaluated as a potential risk stratification instrument in hemodynamically stable patients presenting after BAT 43. The investigators examined the association between FAST findings and laparoscopy/laparotomy, angiographic embolization and death.…”

New Perspectives for Modern Trauma Management – Lessons Learned from 25 Years FAST and 15 Years E-FAST

“…Hematuria, rib fractures located over the abdomen, lumbar and pelvic fractures [29], severe injuries with a high ISS (Injury Severity Score > 25) [19], severe craniocerebral trauma [25], children and penetrating torso injuries are all predictors that FAST may yield a false-negative result. The role of hemodynamic stability is unclear with controversial results for or against FAST in hemodynamically stable as well as unstable patients [26,[30][31][32][33].…”