Emergency ultrasound-based algorithms for diagnosing blunt abdominal trauma

Stengel, Dirk; Bauwens, Kai; Rademacher, G.; Güthoff, Claas

doi:10.1002/14651858.cd004446.pub3

Cited by 32 publications

(31 citation statements)

References 28 publications

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“…In a Cochrane study of four randomised controlled studies using ultrasound to aid diagnosis of patients with blunt abdominal injury, the authors found that the use of ultrasounds reduced the number of CT scans ordered, but due to the low sensitivity of ultrasound, the conclusion was that having clinical pathways using ultrasound to diagnose patients with suspected blunt abdominal injury was not justified. 4 In another review of the use of DPL or FAST as a screening test before CT abdomen in similar patients, the use of CT was reduced and the rate of missed injuries was not higher in patients who underwent DPL but not FAST. The authors thus did not recommend using FAST as a screening test to reduce the use of CT. 3 Our results are comparable to other studies [5][6][7][8][9][10][11] except for a lower PPV (Table 5).…”

Section: Discussionmentioning

confidence: 99%

“…The rate of missed injuries was not reported higher in those who did not have a CT. 3 It also had no impact on the duration of hospitalisation. 4 Likewise, we might translate to our patients performing CTAPs. In our series, patients with false negative FAST who required laparotomy were haemodynamically unstable, except for a patient with an incidental finding of a perforated appendix.…”

Section: Discussionmentioning

confidence: 99%

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Focused Assessment with Sonography in Trauma (FAST): Experience of a Tertiary Hospital in Southeast Asia

Wong¹,

Ngo

Wee³

et al. 2014

Hong Kong Journal of Emergency Medicine

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Focused assessment with sonography in trauma (FAST): experience of a tertiary hospital in Southeast Asia創傷超聲重點評估（FAST）：東南亞一間三級醫院的經驗 E Wong 王怡玲, ASY Ngo 吳淑瑩, JCP Wee 黃俊評, JMH Lee 李美華 Objective: This study compares the positive predictive value (PPV) and negative predictive value (NPV) of focused assessment with sonography in trauma (FAST) versus abdominal-pelvic computed tomography scans (CTAP) after blunt abdominal injury as well as the need for abdominal surgery. We also sought to determine if any false negative ultrasound studies were associated with significant morbidity. The results were compared with other studies. Design: Retrospective cross-sectional study. Setting: A tertiary hospital. Methods: Cases were retrieved from the trauma registry and electronic medical records in a tertiary hospital in Singapore over a two year period from 1 January 2009 to 31 December 2010. Exclusion criteria included penetrating trauma and burns. The sonographic finding, computed tomography finding, and the outcome of the patients were retrieved. Diagnostic characteristics including predictive values were calculated. Results: A total of 476 patients were enrolled. Four hundred fifty-nine patients had FAST performed with fifty (10.9%) being positive. Forty-nine patients (21.7%) out of 226 patients had CTAP which showed abnormalities and nineteen (4.0%) patients underwent surgery. Comparing FAST to detect abnormalities on CTAP, the PPV and NPV were 0.590 and 0.863 respectively. Comparing FAST with the need for surgery, the PPV and NPV were 0.280 and 0.990 respectively. Four patients (0.98%) had negative FAST but required surgery. There were no significant adverse outcomes or surgical intervention in patients with normal vital signs, normal initial physical examination and negative FAST findings but who did not have a CTAP. Conclusions: In patients with an initial normal physical examination and negative FAST, emergent CTAP may be avoided. (Hong Kong j.emerg.med. 2014;21:230-236) 目的：本研究比較了創傷超聲重點評估（ FAST ）與腹腔 / 盆腔 CT 掃描（ CTAP ），在腹部閉合性損傷的陽性預測值（ P P V ）和陰性預測值（ NP V ），以及是否需要腹部手術。我們還試圖確定假陰性的超聲檢查，是否與有重大的併發症有關。並將結果與其他研究進行比較。設計：回顧性橫斷面研究。

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Focused Assessment with Sonography in Trauma (FAST): Experience of a Tertiary Hospital in Southeast Asia

Wong¹,

Ngo

Wee³

et al. 2014

Hong Kong Journal of Emergency Medicine

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“…The Cochrane review database was also directly reviewed, but only a review previously identified by the Pubmed search strategy was identified. 1 One reference selected for full text review was not available, 2 but its data was included in the Cochrane review. This review focused on identifying sources helpful in evaluating a patient-level model of costs and outcomes that compared use of ultrasound to an alternative clinical scenario (i.e., no use of ultrasound).…”

Section: Methodsmentioning

confidence: 99%

“…A Cochrane review ( 1 ) meta-analysis quantitatively synthesized 4 studies 2,5,6,22 and found CT scans were reduced by a risk differences estimate of -0.52 [95% CI -0.82 to -0.21]. 1 One of the included studies, a relatively small prospective randomized controlled trial with 208 enrolled patients at a single Level 2 trauma center with CT scan use as a primary endpoint showed significantly fewer patients required a CT scan after an ultrasound scan [36 vs 52%, difference in proportions 15.9 (CI 2.6-29.1)]. 22 In a prospective study in a single pediatric emergency department (n=128 ultrasound scans of abdominal trauma patients) not included in the Cochrane review, surgeons indicated they would have cancelled CT scans in 48% of cases.…”

Section: Patient-and Institution-level Factorsmentioning

confidence: 99%

Evidence for cost-effectiveness of ultrasound in evaluation of blunt trauma patients

Lane

2016

Emerg Care J

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The evaluation of the blunt trauma patient frequently includes the focused assessment with sonography for trauma (FAST) exam. Additional point-of-care applications for ultrasound in blunt trauma patients are emerging. Ultrasound is a noninvasive diagnostic technique generally considered to be relatively inexpensive, offering the potential for improved outcomes and lower costs. However, formal evaluation of ultrasound's effect on cost-effectiveness has occurred in a piecemeal fashion. The aim of this review is to evaluate the available evidence regarding whether ultrasound is cost-effective for evaluation of blunt trauma patients, and what factors may affect its cost-effectiveness.

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“…Total US presents, as main advantages, its low cost, availability, portability, the chance to reexam several times the same patient, and the lack of use of ionizing radiation or contrast. It may also present false-negative results, since it depends on the examiner and not always detects minor bleeding or intraperitoneal lesions 4,5 . Its result may be compromised by gas interposition, obesity or empty bladder.…”

mentioning

confidence: 99%

Ruling out intra-abdominal injuries in blunt trauma patients using clinical criteria and abdominal ultrasound

Moura

Parreira

Mattos

et al. 2017

Rev. Col. Bras. Cir.

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Objective: to identify victims of blunt abdominal trauma in which intra-abdominal injuries can be excluded by clinical criteria and by complete abdominal ultrasonography. Methods: retrospective analysis of victims of blunt trauma in which the following clinical variables were analyzed: hemodynamic stability, normal neurologic exam at admission, normal physical exam of the chest at admission, normal abdomen and pelvis physical exam at admission and absence of distracting lesions (Abbreviated Injury Scale >2 at skull, thorax and/or extremities). The ultrasound results were then studied in the group of patients with all clinical variables evaluated. Results: we studied 5536 victims of blunt trauma. Intra-abdominal lesions with AIS>1 were identified in 144 (2.6%); in patients with hemodynamic stability they were present in 86 (2%); in those with hemodynamic stability and normal neurological exam at admission in 50 (1.8%); in patients with hemodynamic stability and normal neurological and chest physical exam at admission, in 39 (1.5%); in those with hemodynamic stability, normal neurological, chest, abdominal and pelvic physical exam at admission, in 12 (0.5%); in patients with hemodynamic stability, normal neurological, chest, abdominal and pelvic physical exam at admission, and absence of distracting lesions, only two (0.1%) had intra-abdominal lesions. Among those with all clinical variables, 693 had normal total abdominal ultrasound, and, within this group, there were no identified intra-abdominal lesions. Conclusion: when all clinical criteria and total abdominal ultrasound are associated, it is possible to identify a group of victims of blunt trauma with low chance of significant intra-abdominal lesions.

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Emergency ultrasound-based algorithms for diagnosing blunt abdominal trauma

Abstract: There is currently insufficient evidence from RCTs to justify promotion of ultrasound-based clinical pathways in diagnosing patients with suspected blunt abdominal trauma.

Cited by 32 publications

References 28 publications

Focused Assessment with Sonography in Trauma (FAST): Experience of a Tertiary Hospital in Southeast Asia

Focused Assessment with Sonography in Trauma (FAST): Experience of a Tertiary Hospital in Southeast Asia

Evidence for cost-effectiveness of ultrasound in evaluation of blunt trauma patients

Ruling out intra-abdominal injuries in blunt trauma patients using clinical criteria and abdominal ultrasound

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