Screening US for Blunt Abdominal Trauma: Objective Predictors of False-Negative Findings and Missed Injuries

ABSTRACT:Objectives:To determine whether focused abdominal sonogram for trauma (FAST) in a rural hospital provides information that prompts immediate transfer to a tertiary care facility for patients with blunt abdominal trauma who would otherwise be discharged or held for observation.Methods:Prior to the study, participating emergency physicians underwent a minimum of 30 hours of ultrasound training. All patients who presented with blunt abdominal trauma to our rural hospital between Mar. 1, 2002, and Apr. 30, 2003, were eligible for study. Following a history and physical examination, the emergency physician documented his or her disposition decision. A FAST was then performed, and the disposition reconsidered in light of the FAST results.Results:Sixty-seven FAST exams were performed on 65 patients. Three examinations (4.5%) were true-positive (95% confidence interval [CI] 0.9%–12.5%); 60 (89.6%) were true-negative (95% CI 79.7%–95.7%), 4 (6%) were false-negative (95% CI 1.7%–14.6%) and none (0%) were false-positive (95% CI 0%–5.4%). These values reflect sensitivity, specificity, negative predictive value and positive predictive values of 43%, 100%, 94% and 100% respectively. FAST results did not alter the decision to transfer any patient (0%: 95% CI 0.0%–5.4%), although one positive FAST may have led to an expedited transfer. One of 38 patients who was discharged after a negative FAST study returned 24 hours later because of worsening symptoms, and was ultimately found to have splenic and pancreatic injuries.Conclusions:This study failed to demonstrate that FAST improves disposition decisions for patients with blunt abdominal trauma who are evaluated in a hospital without advanced imaging or on-site surgical capability. However, the study is not sufficiently powered to rule out a role for FAST in these circumstances, and our data suggest that up to 5.4% of transfer decisions could be influenced by FAST. Rural emergency physicians should not allow a negative FAST study to override a clinical indication for transfer to a trauma centre; however, positive FAST studies can be used to accelerate transfer for definitive treatment.

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Repeat abdominal computed tomography scans after pediatric blunt abdominal trauma: missed injuries, extra costs, and unnecessary radiation exposure

Journal of Pediatric Surgery ◽

10.1016/j.jpedsurg.2010.06.007 ◽

2010 ◽

Vol 45 (10) ◽

pp. 2019-2024 ◽

Cited By ~ 31

Author(s):

Steven H. Cook ◽

Julia R. Fielding ◽

J. Duncan Phillips

Keyword(s):

Computed Tomography ◽

Radiation Exposure ◽

Abdominal Trauma ◽

Blunt Abdominal Trauma ◽

Abdominal Computed Tomography ◽

Missed Injuries ◽

Computed Tomography Scans ◽

Unnecessary Radiation

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Significance of Fast in Blunt Abdominal Trauma

Diyala Journal of Medicine ◽

10.26505/djm.19025620915 ◽

2020 ◽

Vol 19 (2) ◽

pp. 140-146

Author(s):

Amir Hinbis Masawod ◽

◽

Hazim Jabbar Kashtal ◽

Ahmed Modher Khalaf

Keyword(s):

Emergency Department ◽

Abdominal Trauma ◽

Blunt Abdominal Trauma ◽

Predictive Value ◽

False Negative ◽

Trauma Patients ◽

True Negative ◽

Abdominal Emergency ◽

Negative Results ◽

False Negative Results

Background: Blunt abdominal trauma is a common problem in our country.Some of the cases had been explored on no bases which were negative by FAST(focused assessment with sonography of trauma)FAST is a tool to detect intra-abdominal collection. Objective: To appreciate the value of (FAST) in blunt abdominal trauma. Patients and Methods: This study performed by a collection of 100 cases of blunt abdominal trauma admitted to the emergency department at Baquba Teaching Hospital from the period 1st January, 2013 to 31st December 2013 fast performed on all cases to detect any intra-abdominal collection, then correlation with this result and laparotomy or conservative results. Results: Out of 100 patients, Twenty seven cases had intra-abdominal collection and seventy three cases had no intra-abdominal collection by fast, 27 cases were positive and one case false positive and 73 cases were negative and 2 false-negative results and 71 true negative. The sensitivity was 92.8 % and specificity 98.6%. The positive predictive value was 96.2 % and negative predictive value 97.2 % and the accuracy 97 %. Conclusion: Focused assessment sonography of trauma can detect intra-abdominal fluid accurately and rapidly, FAST potentially valuable tool for better assessment of trauma in the emergency department. Keywords: Focus assessment with sonography of trauma (FAST), blunt abdominal trauma, abdominal emergency

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BLUNT ABDOMINAL TRAUMA WITH HAEMOPERITONEUM TREATED BY EXPLORATORY LAPAROTOMY VERSUS ONLY ABDOMINAL DRAINAGE: A PROSPECTIVE AND COMPARATIVE STUDY.

International Journal of Medical and Biomedical Studies ◽

10.32553/ijmbs.v4i1.842 ◽

2020 ◽

Vol 4 (1) ◽

Author(s):

Dhawal Panchal ◽

Firdaus Dekhaiya ◽

Harin Tailor

Keyword(s):

Hospital Stay ◽

Abdominal Trauma ◽

Blunt Abdominal Trauma ◽

Exploratory Laparotomy ◽

Blunt Injury ◽

Abdominal Drainage ◽

Duration Of Hospital Stay ◽

Considerable Morbidity ◽

Injured Patients

In today’s mechanized world, Blunt Abdominal Trauma (BAT) is a common emergency which is associated with considerable morbidity and mortality. More than 75% of abdominal traumas are blunt in nature and liver and spleen are the commonest organs to be injured as a result of BAT. The aim is to analyse and compare two groups of patient of blunt abdominal trauma managed conservatively with drainage and one by exploratory laparotomy. 50 cases of blunt abdominal trauma were taken. The patient were studied which includes age ,sex, mode of injury, initial vitals on presentation, Mortality in each group, duration of hospital stay, pre interventions and post interventions state and requirements, complications and follow up. It was observed 48% of patients were in between age group ranging from 10 to 30. Overall in terms of sex ratio, males dominated the no. of cases. RTA was most common mode of trauma. Liver and spleen was most common organ to be injured. Patients managed by laparotomy had higher mortality rate, duration of hospital stay was more, and complication were more. Early diagnosis and repeated clinical examination and use of appropriate investigation form the key in managing blunt injury abdomen patients. Keywords: Blunt Abdominal Trauma, Haemoperitoneum , laparotomy , Abdominal Drainage.

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