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

Abstract

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。