FAST Scan in the Diagnosis of Haemoperitoneum of Haemodynamically Stable Patients with Suspected Blunt Abdominal Trauma
- Report By: Miriam Ball - Foundation Year 2 Trainee
- Search checked by Mr Wilkey - A&E Consultant
- Institution: QE II Hospital, Welwyn Garden City
- Date Submitted: 3rd July 2007
- Last Modified: 4th July 2007
-
Status:
Blue (submitted but not checked)
Three Part Question
In [haemodynamically stable patients with blunt abdominal trauma] how useful is [Focussed Assessment with Ultrasound for Trauma] at [diagnosing haemoperitoneum]?Clinical Scenario
A 25 year old haemodynamically stable patient presents to the emergency department following a high speed RTA with suspected intraabdominal injury. You wonder whether an FAST scan would be helpful for diagnosis.Search Strategy
Medline 1966-03/07 using the Medline interface.[Focussed AND ultrasound AND abdominal trauma AND sensitivity]
Search Outcome
65 papers were found of which 62 were irrelevant or of insufficient quality for inclusion. The remaining 3 papers are shown below.Relevant Paper(s)
| Author, date and country | Patient group | Study type (level of evidence) | Outcomes | Key results | Study Weaknesses |
|---|---|---|---|---|---|
| Miller, MT et al. 2003 USA | 372 haemodynamically stable patients with suspected BAI (Blunt Abdominal Injury) (age 2-93) at a level I trauma centre) | Diagnositic cohort, prospective | Hemoperitoneum | Sensitivity: 42% Specificity: 98% Positive Predicitive Value: 67% Negative Predicitive Value: 93% Accuracy: 92% Discordance US/CT: significant Power: 92% | Objectives not clearly defined |
| Rozycki, MD et al. 1998 USA | 1197 haemodynamically stable patients with suspected BAI (Blunt Abdominal Injury) (age 15-84) at an urban level I trauma centre) with a minimum of an 24h observation period | Diagnositic cohort, prospective | Haemoperitoneum | Sensitivity: 75% Specificity: 99.8% | Not all patients underwent CT scan. |
| Lee, BC et al. 2007 USA | 3907 haemodynamically stable patients with suspected BAI (Blunt Abdominal Injury) at a regional level I trauma centre) | Diagnositic cohort, retrospective | Hemoperitoneum | Sensitivity: 85% Specificity:96% Positive Predicitve Value: 59% Negative Predicitve Value: 99% Accuracy: 96% | Retrospective, selection of patients based on completeness of clinical/radiological/surgical information |
Comment(s)
These studies show that Focussed Assessment with Ultrasound of Trauma has a high specificity for the diagnosis of haemoperitoneum. Data on its sensitivity in this clinical scenario are inconsistent. Further research investigating the sensitivity in a prospective powerful study with application of an independent gold standard test for all subjects is warranted.Clinical Bottom Line
A positive FAST scan is highly specific and can be used to rule in haemoperitoneum in haemodynamically stable patients with suspected blunt abdominal injury.References
- Miller, MT et al. Not so fast J Trauma 2003;54(1):52-9.
- Rozycki GS et al. Surgeon-Performed Ultrasound for the Assessment of Truncal Injuries: Lessons learned from 1540 Patients Annals of Surgery 1998;228(4):557-567
- Lee BC et al. The Utility of Sonography for the Triage of Blunt Abdominal Trauma Patients to Exploratory Laparotomy American Journal of Roentgenology 2007; 188: 415-421