2,576 Ultrasounds for Blunt Abdominal Trauma

Dolich, Matthew; McKenney, Mark; Varela, J. Esteban; Compton, Raymond P.; McKenney, Kimberley L.; Cohn, Stephen M.

doi:10.1097/00005373-200101000-00019

Cited by 206 publications

(105 citation statements)

References 22 publications

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“…In blunt trauma studies investigating FAST scanning, outcomes have demonstrated an average specificity of 90 -99% and sensitivity of 86 -99%. [4][5][6][7][8] Sensitivity in this study was therefore comparable. In accordance with previous evidence, our study also demonstrated excellent specificity of FAST (100%) regardless of mechanism of injury.…”

Section: Discussionsupporting

confidence: 55%

FAST scanning in the developing world emergency department

Smith

Postma²,

Wood³

2010

S Afr Med J

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Section: Discussionsupporting

confidence: 55%

FAST scanning in the developing world emergency department

Smith

Postma²,

Wood³

2010

S Afr Med J

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“…[1][2][3] Its use has been well documented in the United States and Europe in multiple studies. Although it can clearly be an important diagnostic modality in a number of situations such as pericardial tamponade, EPs can be at a great disadvantage when performing the FAST examination since our patients are not ''prepared'' prior to the evaluation.…”

Section: Discussionmentioning

confidence: 99%

“…ACA-DEMIC EMERGENCY MEDICINE 2002; 9:48-53 T HE focused abdominal sonography for trauma (FAST) examination is perhaps the most accepted bedside ultrasound (US) application in emergency medicine (EM) and trauma surgery. [1][2][3][4][5] While the true utility of the FAST exam is still being defined in North America, most of the issues with its use and accuracy have been settled in other countries such as Germany. 6,7 One of the difficulties encountered by emergency physicians (EPs) is trouble in adequately visualizing the required landmarks in obese and other difficult-toscan patients.…”

mentioning

confidence: 99%

Tissue Harmonic Imaging Improves Organ Visualization in Trauma Ultrasound When Compared with Standard Ultrasound Mode

Blaivas

DeBehnke

Sierzenski

et al. 2002

Academic Emergency Medicine

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Abstract. The focused abdominal sonography for trauma (FAST) examination is complicated by brightly lit trauma bays, limited time, and body habitus. Recently, new ultrasound (US) technology has become available that improves organ visualization in abdominal scans. Objective: The hypothesis was that a new US mode, tissue harmonic (TH) imaging, improves visualization of critical organ relationships in the FAST examination by making use of previously unused frequencies. The authors performed a blind, prospective observational study to compare the images obtained in typical FAST views with those obtained in standard US and TH modes. Methods: Blunt trauma patients presenting to a level I trauma center between April and September 2000 were enrolled on a convenience basis. Typical FAST views were obtained in standard and TH modes. The emergency ultrasonographer (EU) switched between modes for each view, optimizing the gain each time. Multiple digital still images were made with all indications of the mode used disguised. For each view on a patient, the best image in each mode was selected in a blinded fashion. Three experienced EUs, blinded to the mode used, rated each image pair for resolution, detail, and total image quality as previously defined on a ten-point Likert scale, 10 being the best for each category. Wilcoxon signed-ranks test, 95% confidence intervals (95% CIs), and interobserver correlation were calculated. Results: A total of 76 image groups (39 of Morison's pouch, 20 splenorenal, and 17 bladder) from 52 patients were rated. Tissue harmonics produced improved resolution, detail, and quality when compared with the standard US mode, with median scores of 6.7 vs. 6.0, 6.7 vs. 6.0, and 6.3 vs. 6.0, respectively. The differences of 0.7 (95% CI = 0.4 to 0.93), 0.7 (95% CI = 0.4 to 0.93), and 0.33 (95% CI = 0.17 to 0.67) were statistically significant, with p = 0.0001, 0.0001, and 0.0003, respectively. There was good interobserver agreement (kappa = 0.74; 95% CI = 0.68 to 0.79). Conslusions: Tissue harmonics produced FAST images higher in detail, resolution, and total image quality than standard-mode US images.

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“…A critical part of training is the presence of an adequate number and variability of positive examinations. The positive FAST rate is reported to be 9% to 13% [27,[40][41][42]. Thus, with 50 sequential examinations, a provider may have less than 10 positive examinations.…”

Section: Training and Credentialingmentioning

confidence: 99%

Ultrasound in abdominal trauma

Rose

2004

Emergency Medicine Clinics of North America

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Ultrasound in the evaluation of abdominal trauma has evolved over the past 30 years. The use of ultrasound for abdominal trauma was described initially by Kristensen and colleagues [1] in 1971. In 1976, Ascher and colleagues [2] first reported the accuracy of ultrasound in Radiology, with 80% sensitivity for the detection of splenic injury. In a study of 808 patients, Tiling and colleagues [3] in 1990 reported a sensitivity of 89%, a specificity of 100%, and an accuracy of 98%. This same group also was first to comment on the effect of training and experience and reported that surgeons with extensive ultrasound experience could diagnose intra-abdominal fluid with a sensitivity of 96% and an accuracy of 99%. Interest and experience with ultrasound for trauma grew steadily around the world among surgeons and emergency physicians during the early 1990s [4][5][6][7]. During this period, ultrasound technology was improving with regard to price, portability, and resolution, allowing its use during resuscitation. At the same time, in the United States, there was continuing reliance on diagnostic peritoneal lavage (DPL) and CT and much less interest in sonography for abdominal trauma. This all changed when emergency physicians and surgeons in the United States began to publish their experience with ultrasound [4,8,9]. The term Focused Assessment with Sonography for Trauma (FAST) was coined by Rozycki et al [10] in 1996 and has persisted as the accepted acronym for the trauma ultrasound evaluation. The basic four-view examination (perihepatic, perisplenic, pelvic, and pericardial views) has become the foundation of the FAST examination. The rapid, noninvasive, and practical nature of ultrasound for bedside evaluation of critically injured patients has changed the evaluation of blunt abdominal trauma.

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2,576 Ultrasounds for Blunt Abdominal Trauma

Abstract: Emergency US is highly reliable and may replace computed tomographic scan and diagnostic peritoneal lavage as the initial diagnostic modality in the evaluation of most patients with BAT.

Cited by 206 publications

References 22 publications

FAST scanning in the developing world emergency department

FAST scanning in the developing world emergency department

Tissue Harmonic Imaging Improves Organ Visualization in Trauma Ultrasound When Compared with Standard Ultrasound Mode

Ultrasound in abdominal trauma

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