Original Scientific ArticlesAn algorithm to reduce the incidence of false-negative FAST∗∗ examinations in patients at high risk for occult injury1
Section snippets
Methods
An algorithm was prospectively used for evaluating select injured patients (nonconsecutive sample) who were admitted to our Level I trauma center during a 3-year period. To be entered into the study, adult patients had to have a blunt mechanism of trauma, a negative FAST examination, and either a spine fracture with or without cord injury, or a pelvic fracture. Although several types of injuries are associated with high energy impact and the potential for occult injury, only those patients
Results
During a 3-year period, 1,490 patients with blunt mechanisms of injury had FAST examinations by surgeon-sonographers. One hundred two (6.8%) of those patients entered this study, the majority (86%) of whom were men. The mean age and the mean Injury Severity Score (ISS) of the study population were 34 ± 0.5 years and 36 ± 12 years, respectively. (Of note, the sensitivity and specificity of the other 1,389 patients were 79.8% and 79.1%, respectively).
Discussion
As a rapid and accurate method to detect hemoperitoneum, the FAST examination is suitable for the evaluation of most patients with blunt mechanisms of injury.1, 2, 3, 4, 9, 10, 11, 12, 13, 14, 15, 16 Its inability to detect consistently multiple injuries as previously mentioned has been reported as the reason for false-negative results in several studies,1, 3, 12, 17, 19 and an additional CT scan of the abdomen is occasionally recommended. Data that further define the indications for a CT scan
Invited commentary
David B Hoyt San Diego, CA
I’d like to congratulate Dr Ballard and his colleagues for their leading work in the development of ultrasound for the evaluation of abdominal trauma, and for their ongoing refinement how best to use this important advance for taking care of trauma patients.
The current study hypothesizes that energy transfer associated with spinal fractures and pelvic fractures might be associated with a higher incidence of “missed injuries” when evaluated by ultrasound and should
Reply
Grace S Rozycki, md, rdms, facs
Atlanta, GA
The authors would like to express our appreciation to Dr Hoyt for his insightful discussion of our manuscript.
Although we cannot give an exact figure for the “miss rate” for small bowel, diaphragm, and bladder injuries for patients who were evaluated by CT scan, we do recommend the use of several modalities if the index of suspicion is particularly high for these injuries. For example, the patient whose CT scan of the abdomen has fluid but no solid
Acknowledgements
The authors would like to express their appreciation to the residents of the Department of Surgery from Emory University School of Medicine, and to Christa Gardner for her valuable assistance with the preparation of this manuscript.
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Focused Assessment for the Sonographic Examination of the Trauma patient.
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No competing interests declared.