The Value of Focused Assessment Sonography for Trauma the Management of Patients with Blunt Trauma to the Abdomen
Iraqi Postgraduate Medical Journal,
2015, Volume 14, Issue 3, Pages 379-384
During the last decade focused assessment with sonography for trauma increasingly has become the initial diagnostic modality of choice in trauma patients.
This study was carried to evaluate the sensitivity, specificity and accuracy of FAST when done by residents in the emergency surgical department, & its effect in determining the type of management.
PATIENTS AND METHOD:
210 patients with blunt abdominal trauma were assessed with FAST within 30 minutes from admission to the emergency room. FAST results were considered positive if it detected intra peritoneal fluid , negative if it did not detect intra peritoneal fluid , and indeterminate (equivocal) if the results were not conclusive.
In cases with negative Fast results and no other injuries were detected the patients were kept in the emergency department for 24 hours for observation and discharged later on.
Those with indeterminate initial FAST or who deteriorated clinically after negative initial FAST were subjected to repeated FAST and / or emergency abdominal and pelvic computed tomography (C.T scan) or explorative laparotomy according to their clinical condition.
Patients with positive ultrasonography results underwent emergency abdominal or pelvic C.T, or surgery according to their clinical picture.
From the 210 patients included in the study we found that 177 patients (84.2) % had negative FAST results, 22 patients (10.4)% had positive FAST results , 2 patients (0.95)% had false positive results , 8 patients (3.8)% had false negative FAST results and 11 patients (5.2)% had equivocal FAST results.
After exclusion of equivocal cases , FAST had sensitivity of (71.4)% specificity of (98.8)% , accuracy of (89.1)%, positive predictive value of (90.9)% and negative predictive value of(95.4)%.
FAST is useful adjunct to the initial evaluation of blunt trauma patients with reliable accuracy & high negative predictive value.
FAST had a great effect in determining the type of treatment especially in case of mass causality.
And using FAST by general surgeons helps in the determination of the type of treatment for patients with blunt trauma.
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