Findings and limitations of focused ultrasound as a possible screening test in stable adult patients with blunt abdominal trauma: a Greek study

Abstract

Our objective is to underline the place of FAST (focus assessment by sonography for trauma) ultrasonography (US) in the investigation of blunt abdominal trauma. We retrospectively examined the ultrasound findings in 1,999 haemodynamically stable adult patients. These people were admitted to the emergency room (ER) for possible blunt abdominal trauma. All were stable at admission and a FAST ultrasound examination was made. Initial findings were compared with the clinical course after at least 24 h of observation time and CT results. Among the 1,999 US examinations, abnormalities were found in 109 (5.5%) cases. Among them, 102 had free peritoneal fluid, and in 58 examinations, ruptures, lacerations or haematomas were demonstrated. Despite its limitations, such as in cases involving uncooperative patients, excessive bowel gas, obesity and empty bladder, the FAST technique seems to be an accurate method to evaluate the possibility of abdominal blunt trauma in stable patients. Because of the high negative predictive value of the FAST technique in stable patients with blunt abdominal trauma, we recommend that a stable patient with negative ultrasound results at admission remain under close observation for at least 12 or preferably 24 h before being discharged.

Do we really rely on fast for decision-making in the management of blunt abdominal trauma?

“…In addition to the operator-dependency, amount of intraabdominal fluid, factors resulting in a false negative FAST examination also include patients' body habitus. In obese patients and those with subcutaneous emphysema the false negative rate would increase [16,17]. In the current study, there was no difference in terms of body mass index (BMI) between the positive and false negative groups.…”

Trauma Ultrasound

“…For those with stable vital signs (at presentation or after initial resuscitation), intraperitoneal free fluid prompts CT to better define the nature of injuries. Clinical observation, repeated FAST, contrast-enhanced US or CT may follow a negative FAST in this setting (Kornezos et al 2010;). In the latter scenario, if organ injury is suspected on FAST, CT is warranted.…”

“…Although it is ideal to perform FAST before placement of a urinary catheter, this is not always possible. An empty urinary bladder can reduce the diagnostic accuracy of FAST in detection of pelvic free fluid (Kornezos et al 2010). If the exam is negative in other views, the bladder could be refilled with saline and the pelvic scan repeated to ensure true negativity.…”

Contrast-Enhanced Ultrasound for Imaging Blunt Abdominal Trauma – Indications, Description of the Technique and Imaging Review

“…It is the most common site of blunt abdominal trauma, the liver being second [30]. The spleen has a longstanding irregular arterial phase, due to different uptake rates between the red and white pulp ("zebra appearance"), disappearing 40 -60 sec post-injection.…”