Moylan Mark, Newgard Craig D, Ma O John, Sabbaj Alfredo, Rogers Tracy, Douglass Rachelle
Center for Policy and Research in Emergency Medicine, Department of Emergency Medicine, Oregon Health & Science University, Portland, Oregon 97201-3098, USA.
J Emerg Med. 2007 Oct;33(3):265-71. doi: 10.1016/j.jemermed.2007.02.030. Epub 2007 Jul 5.
Although a positive FAST (focused assessment with sonography for trauma) examination in hypotensive blunt trauma patients generally suggests the need for emergent laparotomy, this finding's significance in normotensive trauma patients is unclear. We tested the association between a positive FAST and the need for therapeutic laparotomy in normotensive blunt trauma patients. This was a retrospective cohort analysis of consecutive normotensive blunt trauma patients presenting to two trauma centers. The outcome was therapeutic laparotomy. The unadjusted association between a positive FAST and laparotomy was odds ratio (OR) 116 (95% confidence interval [CI] 49.5-273). This association persisted after adjusting for confounding variables (OR 44.6, 95% CI 1.77-1124). Thirty-seven percent of patients with a positive FAST required therapeutic laparotomy vs. 0.5% with a negative FAST. Among normotensive blunt trauma patients, there was a strong association between a positive FAST and the need for therapeutic laparotomy. Very few normotensive patients with a negative FAST required therapeutic laparotomy.
虽然对于低血压性钝性创伤患者，阳性的FAST（创伤超声重点评估）检查通常提示需要紧急剖腹手术，但这一发现对于血压正常的创伤患者的意义尚不清楚。我们检测了血压正常的钝性创伤患者中阳性FAST与治疗性剖腹手术需求之间的关联。这是一项对两个创伤中心收治的连续性血压正常的钝性创伤患者进行的回顾性队列分析。结局指标是治疗性剖腹手术。FAST阳性与剖腹手术之间未经调整的关联的比值比（OR）为116（95%置信区间[CI] 49.5 - 273）。在对混杂变量进行调整后，这种关联仍然存在（OR 44.6，95% CI 1.77 - 1124）。FAST阳性的患者中有37%需要进行治疗性剖腹手术，而FAST阴性的患者中这一比例为0.5%。在血压正常的钝性创伤患者中，FAST阳性与治疗性剖腹手术需求之间存在很强的关联。FAST阴性的血压正常患者中极少有人需要进行治疗性剖腹手术。
