FAST Scan in the Diagnosis of Haemoperitoneum of Haemodynamically Stable Patients with Suspected Blunt Abdominal Trauma
Date First Published:
July 3, 2007
Last Updated:
July 4, 2007
Report by:
Miriam Ball, Foundation Year 2 Trainee (QE II Hospital, Welwyn Garden City)
Search checked by:
Mr Wilkey, QE II Hospital, Welwyn Garden City
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.
Search Details:
[Focussed AND ultrasound AND abdominal trauma AND sensitivity]
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):
| Study Title | Patient Group | Study type (level of evidence) | Outcomes | Key results | Study Weaknesses |
|---|---|---|---|---|---|
| Not so fast 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%<br><br>Specificity: 98%<br><br>Positive Predicitive Value: 67%<br><br>Negative Predicitive Value: 93%<br><br>Accuracy: 92%<br><br>Discordance US/CT: significant<br><br>Power: 92% | Objectives not clearly defined |
| Surgeon-Performed Ultrasound for the Assessment of Truncal Injuries: Lessons learned from 1540 Patients Rozycki GS 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%<br><br>Specificity: 99.8% | Not all patients underwent CT scan. |
| The Utility of Sonography for the Triage of Blunt Abdominal Trauma Patients to Exploratory Laparotomy 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%<br><br>Specificity:96%<br><br>Positive Predicitve Value: 59%<br><br>Negative Predicitve Value: 99%<br><br>Accuracy: 96% | Retrospective, selection of patients based on completeness of clinical/radiological/surgical information |
Author Commentary:
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.
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
- Rozycki GS et al.. Surgeon-Performed Ultrasound for the Assessment of Truncal Injuries: Lessons learned from 1540 Patients
- Lee BC et al.. The Utility of Sonography for the Triage of Blunt Abdominal Trauma Patients to Exploratory Laparotomy