FAST as a predictor of clinical outcome in blunt abdominal trauma

Background. Peer-reviewed literature demonstrates increasing support for the use of focused abdominal sonography in trauma (FAST) in the setting of blunt trauma, one study demonstrating the sensitivity and specificity of FAST for the detection of free fluid to be 0.64 - 0.98 and 0.86 - 1.00, respectively, compared with abdominal CT. Utilising ultrasound in trauma triage increases efficiency and cost-effectiveness and reduces reliance on CT, compared with using CT alone. There is little evidence to support relying solely on a negative FAST and physical examination for patient management. Method. A retrospective descriptive study of 172 adult patients who received FAST for the evaluation of blunt abdominal trauma between 22 July 2007 and 21 January 2008 at Tygerberg Hospital was performed. Ultrasound findings were correlated with CT scan findings, operative findings if managed surgically, clinical outcomes whether managed surgically or conservatively, as well as postmortem findings in deceased patients. Results. FAST was negative in 147 (85.5%) patients. Twenty-four (16.3%) of these patients died from all-cause mortality, none of which was due to intra-abdominal injury. Seven patients with negative FAST underwent CT scan owing to change in clinical course, and 3 patients with negative FAST underwent laparotomy owing to change in clinical course, with positive findings in 2 patients – a bowel injury requiring resection (not seen on CT) and a diaphragmatic rupture seen on CXR. A negative FAST was shown to be an excellent predictor for the absence of significant intra-abdominal trauma. The mortality rate among 25 FAST positive patients was 24% (N=6). Only one of these patients (with a splenic rupture) was suspected to have died from abdominal pathology.

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Role of Sonographic Imaging Findings in Evaluation of Cases Presenting with History of Blunt Abdominal Trauma in UCMS-TH

Journal of Universal College of Medical Sciences ◽

10.3126/jucms.v8i02.34243 ◽

2020 ◽

Vol 8 (02) ◽

pp. 11-14

Author(s):

Sanju Rawal ◽

Sadhan Mukhi

Keyword(s):

Ct Scan ◽

Abdominal Trauma ◽

Blunt Abdominal Trauma ◽

Cost Effective ◽

Free Fluid ◽

Solid Organ ◽

Cross Sectional ◽

History Of ◽

Contrast Exposure ◽

One Year

INTRODUCTION Physical examination is often unreliable. Computed tomography scan is costly, time consuming, requires injection of contrast, exposure to radiation and patient transport thereby limiting its use. With the usage of sonography, it is possible to evaluate and help in the management of patients with blunt abdominal trauma. The proposed study enables sonographic technique in assessing and accurately detecting the presence of free fluid and to pin point the injured organ, thereby helping the clinicians and surgeons in appropriate management MATERIAL AND METHODS Our study was cross sectional conducted on UCMS-TH, Bhairahawa, Nepal. Total 150 cases with history of blunt abdominal trauma were included and scanned by GE LOGIQ6 PRO ultrasound scanner for the duration of one year. RESULTS A total of 150 patients were evaluated 121 were males and 29 were females. Free fluid was detected in total 112 cases (74.66%) out of which with most common injured solid organs were Liver and spleen in total 31 cases (20.7%) each, which were further confirmed on CT scan. CONCLUSION Ultrasonography is easy to perform, quick, cost effective and is highly sensitive in detecting free fluid and solid organ injuries however insignificant in patients with bowel or mesenteric injuries in cases of blunt abdominal trauma and demand CT scan.

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Mesenteric Hematoma: Is there a Role for Selective Management?

The American Surgeon ◽

10.1177/000313481608200415 ◽

2016 ◽

Vol 82 (4) ◽

pp. 314-318 ◽

Cited By ~ 3

Author(s):

Camila Corzo ◽

Alan Murdock ◽

Louis Alarcon ◽

Juan C. Puyana

Keyword(s):

Glasgow Coma Scale ◽

Ct Scan ◽

Abdominal Trauma ◽

Blunt Abdominal Trauma ◽

Nonoperative Management ◽

Penetrating Trauma ◽

Free Fluid ◽

Inhospital Mortality ◽

Coma Scale ◽

Mesenteric Hematoma

Mesenteric hematomas may present as a radiologic finding after blunt abdominal trauma that may be associated with surgically significant mesenteric and/or bowel injury. The question of whether to operate or not to operate on patients with mesenteric hematoma remains a topic of debate, especially with the improved imaging technology. This study sought to identify clinical and radiological characteristics for patient selection for operative management (OM) of mesenteric hematoma. A retrospective review of 33 adults with blunt abdominal trauma and mesenteric hematoma on CT scan (2009–2012) was performed. Patients with other intra-abdominal injuries, penetrating trauma, isolated gastric hematoma, contrast extravasation, extraluminal air, and Glasgow Coma Scale < 14 were excluded. Patients requiring surgical treatment within 24 hours of admission were compared with those who did not using chi-squared test, Fisher's exact test, and t test. Parameters included age, gender, race, Glasgow Coma Scale, vital signs, pain, tenderness, ecchymosis, Injury Severity Score, length of stay, and inhospital mortality. Logistic regression was used to determine positive associations with OM. Of the 33 patients, 19 underwent OM and 14 did not. Both groups were similar at baseline. Regression analysis revealed association for pain [odds ratio (OR) = 9.6, confidence interval (CI) = 1.8–49.9, P < 0.01], tenderness (OR = 32, CI = 4.6–222.2, P < 0.01), and free fluid (OR = 10.3, CI = 1.8–60, P < 0.01) with need for operative intervention. Nonoperative management patients had 100 per cent success rate. Of the OM patients, 100 per cent underwent therapeutic laparotomies. Findings of mesenteric hematoma on CT scan in examinable patients with no abdominal pain, tenderness, or free fluid predict successful nonoperative management.

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Blunt abdominal trauma: initial resuscitation followed by clinical and focused abdominal sonography assessment important diagnostic tools of organ injury due to restricted use of CT-scan in a tertiary care in India

International Surgery Journal ◽

10.18203/2349-2902.isj20215152 ◽

2021 ◽

Vol 9 (1) ◽

pp. 174

Author(s):

S. K. Sekendar Ali ◽

Narendra Nath Mukhopadhyay ◽

Jyotirmoy Bhattacharya ◽

Madhusudan Chattopadhyay

Keyword(s):

Ct Scan ◽

Abdominal Trauma ◽

Blunt Abdominal Trauma ◽

Tertiary Care ◽

Diagnostic Tools ◽

Solid Organ ◽

Abdominal Sonography ◽

Initial Resuscitation ◽

Restricted Use

Background: Blunt abdominal trauma (BAT) is one of the common causes of admission in surgical ward in any hospital. It requires high level of suspicion, urgent evaluation and timely management to decrease morbidity and mortality. Objective was to evaluate the role of clinical and ultrasound assessment in early diagnosis of intra-abdominal injury following blunt abdominal trauma and follow up in patients with intraabdominal injury for detecting complications.Methods: 130 patients who presented to the emergency room were evaluated by clinical and focused abdominal sonography for trauma (FAST) and follow-up sonography was done after 6-12 hours upto 72 hours.Results: In our study, road traffic accidents (RTA) were the most common cause of blunt abdominal trauma (70.76%) with 75% patients being were males. X-ray erect abdomen and ultrasound of the abdomen were the most sensitive investigation for hollow viscous injury and solid organ injuries, respectively, with bowel (38.33%) and liver injury (26.67%) being the most common organ involved in this study. This study found sensitivity (93.7%) and specificity (98.5%) of focused abdominal ultrasonography (FAST).Conclusions: Initial resuscitation followed by clinical and ultrasonography assessment is considered the best modality in initial evaluation of blunt abdominal trauma patients as it is noninvasive, readily available, and requires minimal preparation time and also due to restricted use of modern amenities such as CT-scan in tertiary care in India.

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Traumatic Gallbladder Perforation in Children – Case Report and Review

RöFo - Fortschritte auf dem Gebiet der Röntgenstrahlen und der bildgebenden Verfahren ◽

10.1055/a-1339-1904 ◽

2021 ◽

Author(s):

Melanie Thanh Phuong Le ◽

Jochen Herrmann ◽

Michael Groth ◽

Konrad Reinshagen ◽

Michael Boettcher

Keyword(s):

Case Report ◽

Abdominal Trauma ◽

Blunt Abdominal Trauma ◽

Recent Literature ◽

Signs And Symptoms ◽

Gallbladder Wall ◽

Gallbladder Perforation ◽

Free Fluid ◽

Key Points ◽

Magnetic Resonance Imaging Mri

Background Gallbladder perforation is a very rare finding in children. Clinical and radiografic presentations are often vague. Hence it is a challenging diagnosis, often missed during initial evaluation with potentially fatal consequences. The aim of this case report and review was to identify factors that might help to diagnose and manage future cases. Methods We present a case of gallbladder perforation in an 8-year-old child after blunt abdominal trauma caused by a handlebar in which imaging modalities such as ultrasound and magnetic resonance imaging (MRI) helped us to determine proper management. We identified and evaluated comparable cases for isolated traumatic gallbladder injury. A review of the recent literature was performed by online search in Pubmed and Google Scholar using “gallbladder injury in children”, “gallbladder perforation children”, “blunt abdominal trauma children” as keywords. We focused on articles exclusively in the pediatric section. The literature from the period 2000–2020 was taken into account to review the state of the art in diagnosis and management. Results and Conclusion Recent literature for gallbladder injury in pediatrics is sparse compared to the adult counterpart. Only eight published cases of isolated gallbladder injury in children were identified. Since the onset of symptoms may not develop acutely and often develops in an indistinct manner, radiografic examinations play an important role in the diagnostic progress. The authors advise caution in cases of blunt abdominal trauma especially involving handlebars, intraperitoneal free fluid, and severe abdominal pain. We advocate high suspicion of gallbladder perforation if the gallbladder wall displays discontinuation or cannot be definitively differentiated in sonografic examination. Echogenic fluid within the gallbladder should always lead to suspicion of intraluminal bleeding. Repeated clinical and imaging examinations are mandatory since the onset of signs and symptoms may be delayed. Key Points: Citation Format

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CT scan in blunt abdominal trauma

Injury ◽

10.1016/0020-1383(93)90033-3 ◽

1993 ◽

Vol 24 (8) ◽

pp. 541-544 ◽

Cited By ~ 10

Author(s):

S. Sriussadaporn

Keyword(s):

Ct Scan ◽

Abdominal Trauma ◽

Blunt Abdominal Trauma

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Role of Liver Enzymes in Patients with Blunt Abdominal Trauma to Diagnose Liver Injury

10.21203/rs.3.rs-40069/v1 ◽

2020 ◽

Author(s):

Anup Shrestha ◽

Harish Chandra Neupane ◽

Kishor Kumar Tamrakar ◽

Abhishek Bhattarai ◽

Gaurav Katwal

Keyword(s):

Liver Injury ◽

Confidence Interval ◽

Ct Scan ◽

Abdominal Trauma ◽

Blunt Abdominal Trauma ◽

Predictive Value ◽

Liver Enzymes ◽

Tertiary Center ◽

Significant Difference

Abstract Background:The liver is the second most injured organ following blunt abdominal trauma (BAT) after spleen. Although the computed tomography (CT) scan is considered as the gold standard for diagnosing liver injury in BAT, it is not readily available in the hospital. This study was performed to evaluate the role of aspartate transaminase (AST) and alanine transaminase (ALT) in patients with BAT and its significance in predicting the diagnosis and severity of the liver injury.Method:The study was conducted in Chitwan Medical College Teaching Hospital (CMCTH) study from February 2019 to May 2020. During that period 96 patients with BAT presented to the emergency department(ED) of CMCTH.Results:Among the 96 patients admitted with BAT, 38 patients had liver injury and 58 patients had no liver injury. The median length of the intensive care unit (ICU) stay of patients with liver injury was higher than without liver injury. There was a significant difference in the median level of AST and ALT (<0.001) between patients with liver injury and no liver injury. The area under the ROC curve of AST was 0.89(95% Confidence Interval 0.86-0.98) and of ALT was 0.92(95% Confidence Interval 0.83-0.97). The area under the curve demonstrated that the test was a good predictor for the identification of liver injury and also the severity of liver enzymes. The cut-off values for the liver injury were 106 U/l and 80 U/l for AST and ALT respectively. Based on these values, AST ≥ 106 U/l had a sensitivity of 71.7 %, a specificity of 90 %, a positive predictive value of 86.8 %, and a negative predictive value of 77.6 %. The corresponding values for ALT ≥ 80 U/l were 77.8 %, 94.1%, 92.1% and 82.8 %, respectively.ConclusionIn conclusion, we report the optimal cut-off value of AST and ALT for liver injury in BAT as ≥ 106 U/l and 80 U/l respectively. The elevated level of AST and ALT might assist the surgeons to timely refer the suspected patients with the liver to a tertiary center and it might help the surgeons to go for conservative management for minor liver injuries in BAT preventing the exposure hazards of the CT scan.

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Isolated free fluid on computed tomography for blunt abdominal trauma

Annals of The Royal College of Surgeons of England ◽

10.1308/rcsann.2019.0078 ◽

2019 ◽

Vol 101 (8) ◽

pp. 552-557

Author(s):

W Bekker ◽

MTD Smith ◽

VY Kong ◽

JL Bruce ◽

G Laing ◽

...

Keyword(s):

Abdominal Trauma ◽

Blunt Abdominal Trauma ◽

Splenic Injury ◽

Operative Management ◽

Bladder Injury ◽

Free Fluid ◽

Abdominal Ct ◽

Hollow Viscus ◽

Hollow Viscus Injury ◽

Non Operative Management

Introduction The clinical significance of isolated free fluid on abdominal computed tomography (CT) in patients with blunt abdominal trauma is unclear. This audit reviews our unit’s experience with isolated free fluid and attempts to refine our clinical algorithms for the assessment of patients with blunt abdominal trauma. Materials and methods All patients who sustained blunt abdominal trauma between December 2012 and December 2017 who were subjected to multidetector CT of the abdomen as part of their initial investigation were included in this study. Results During the five-year period under review, a total of 1066 patients underwent abdominal CT following blunt poly trauma. A total of 84 (7.9%) patients died. There were 148 (14%) patients with CT finding of isolated free fluid. Of these, 128 (67%) were selected for non-operative management, which included a period of serial abdominal examinations. In this non-operative group, five patients failed their abdominal observations and underwent laparotomy. Findings in these five cases were negative (1), non-therapeutic (1), splenic injury (1), Pancreatic and splenic injury (1) and bladder injury (1). Thirteen patients (10%) died, none of whom had surgery. The causes of death were exsanguination from a major traumatic lower limb injury (1), multiple organ failure (1), traumatic brain injury (10) and spinal cord injury (1). The remaining 20 patients underwent laparotomy. The indications were failed non-operative management (5), abdominal distension (1) and suspicion of a missed hollow viscus injury (14). In this group there were 11 therapeutic and 6 non-therapeutic surgeries and three negative laparotomies. For the 15 patients selected for operative management, the findings were as follows: hollow viscus injury (3), mesenteric bleeds (2), splenic and pancreatic injury (1), liver and bladder injury (1), splenic and bladder injury (1), non-therapeutic (4), negative (3). The finding of isolated free fluid on CT is 98% sensitive and 96% specific for true isolated free fluid (chi square 331.598; P = 0.000). This finding predicts successful non-operative management with a positive predictive value of 93% and a negative predictive value of 96%. Discussion In patients with blunt abdominal trauma, the finding of isolated free fluid on abdominal CT alone is no longer an indication for laparotomy. Other clinical factors must be taken into account when deciding on the need for laparotomy, such as haemodynamic status, clinical abdominal findings and the ability to reliably assess the abdomen. In the absence of a clinical indication for urgent laparotomy, patients with isolated free fluid may be observed.

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