Dammers D, El Moumni M, Hoogland I I, Veeger N, Ter Avest E
Department of Emergency Medicine, Medical Center Leeuwarden, Henry Dunantweg 2, 8934 AD, Leeuwarden, The Netherlands.
Department of Trauma surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
Scand J Trauma Resusc Emerg Med. 2017 Jan 3;25(1):1. doi: 10.1186/s13049-016-0342-0.
Focussed Assessment with Sonography for Trauma (FAST) is a bedside ultrasonography technique used to detect free intraperitoneal fluid in patients presenting with blunt abdominal trauma (BAT) in the emergency department.
In this retrospective cohort study we investigated the potential of FAST as a risk stratification instrument in haemodynamically (HD) stable patients presenting after BAT by establishing the association between the FAST exam result and final outcome. An adverse outcome was defined in this context as the need for either a laparoscopy/laparotomy or an angiographic embolization or death due to abdominal injuries).
A total of 421 patients with BAT were included, of which nine had an adverse outcome (2%). FAST was negative in 407 patients. Six of them turned out to have free intraperitoneal fluid (sensitivity 67 [41-86]%). FAST was positive in 14 patients, 12 of whom had free intraperitoneal fluid (specificity 99 [98-100]%). A positive FAST (positive likelihood ratio 34.3 [15.1-78.5]) was stronger associated with an adverse outcome than Injury Severity Score (ISS) or any individual clinical- or biochemical variables measured at presentation in the ED.
The FAST exam can provide valuable prognostic information at minimal expenses during the early stages of resuscitation in haemodynamically stable patients presenting with BAT.
FAST exam should not be omitted in patients with BAT.
创伤重点超声评估（FAST）是一种床旁超声检查技术，用于急诊科对钝性腹部创伤（BAT）患者检测腹腔内游离液体。
在这项回顾性队列研究中，我们通过建立FAST检查结果与最终结局之间的关联，研究FAST作为血流动力学（HD）稳定的BAT患者风险分层工具的潜力。在此背景下，不良结局定义为需要进行腹腔镜检查/剖腹手术、血管造影栓塞或因腹部损伤死亡。
共纳入421例BAT患者，其中9例出现不良结局（2%）。407例患者FAST检查结果为阴性。其中6例被证实有腹腔内游离液体（敏感性67[41-86]%）。14例患者FAST检查结果为阳性，其中12例有腹腔内游离液体（特异性99[98-100]%）。与损伤严重程度评分（ISS）或急诊科就诊时测量的任何个体临床或生化变量相比，FAST阳性（阳性似然比34.3[15.1-78.5]）与不良结局的相关性更强。
对于血流动力学稳定的BAT患者，FAST检查在复苏早期可以以最小的成本提供有价值的预后信息。
BAT患者不应省略FAST检查。
