Central Surgical AssociationFAST scan: Is it worth doing in hemodynamically stable blunt trauma patients?
Section snippets
Materials and methods
All trauma patients who were admitted to our institute between January 2002 and December 2008 and entered into our trauma database were reviewed. Our center is a state designated level 1 trauma center and is one of the 2 major trauma centers serving the state of Nebraska. Patients are entered prospectively into the trauma database by the trauma service. The registry contains information about all documented injuries and is updated if new or delayed injuries are found. The data analyzed from the
Results
During a 7-year period, 2,980 patients were evaluated by the trauma service in the ER. In all, 850 patients were identified who did not have FAST results recorded in the registry. These patients were excluded, which left 2,130 patients who underwent a FAST examination. The FAST was inconclusive in 18 (0.8%) patients, and 7 (0.3%) patients were dead on arrival, leaving a total of 2,105 patients or 70% of our trauma patients available for analysis. Of the 18 patients with inconclusive FAST scan,
Discussion
Evaluation and management of blunt abdominal trauma continues to be a major challenge for trauma surgeons. FAST conducted emergently in the trauma setting is now used widely in the United States to evaluate hemodynamically unstable blunt trauma patients as it gives a rapid assessment of injuries.1, 2, 3, 4, 5, 6, 7 Its utility in the hemodynamically stable blunt trauma (HSBT) patient, however, remains questionable.8 Although FAST has been shown in multiple studies to be sensitive for detection
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2019, American Journal of SurgeryCitation Excerpt :This is among the first reports of FNR stratified by specific vessel injury; however, prior studies have demonstrated a lack of correlation between presence of vascular injury and positive FAST, specifically in the setting of blunt trauma.7 Still other reports of patients with an initially negative FAST followed by a positive laparotomy have demonstrated high rates of splenic injury requiring splenectomy, liver laceration requiring packing, and mesenteric lacerations requiring repair/resection,8 not to mention the potential for missed injuries to the urinary system, diaphragm, adrenals, or any combination of the above.9 Given the potential clinical implications of missed hemorrhage, we recommend interpreting a negative FAST exam with caution if NCTH is suspected.
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