太快，还是不够快？非压迫性躯干出血患者的 FAST 检查。
Too fast, or not fast enough? The FAST exam in patients with non-compressible torso hemorrhage.
机构信息
Department of Surgery, Madigan Army Medical Center, Tacoma, WA, USA.
Center for Translational Injury Research, University of Texas Health Science Center, Houston, TX, USA.
出版信息
Am J Surg. 2019 May;217(5):882-886. doi: 10.1016/j.amjsurg.2019.02.012. Epub 2019 Feb 13.
BACKGROUND
Focused assessment with sonography for trauma (FAST) performance metrics are unknown in patients with non-compressible torso hemorrhage (NCTH).
METHODS
Retrospective review of a dedicated NCTH database from four level 1 trauma centers (2008-2012). NCTH was defined as (1) named axial torso vessel disruption; (2) AIS chest or abdomen >2 with shock (base deficit < -4) or truncal operation in ≤ 90 min; or (3) pelvic fracture with ring disruption. Patients were grouped by cavity of hemorrhage source and by shock (SBP ≤ 90).
RESULTS
274 patients had a FAST prior to diagnosis of NCTH. FAST was positive in 51% of patients with abdominal/pelvic hemorrhage for a false negative rate (FNR) of 49%. FNR was higher for pelvic (61%) versus abdominal (43%) sources (p = 0.02). There was no difference between FAST negative or positive patients for ISS, shock, length of stay, or mortality (all p = NS). FNR was not improved among the subgroup of NCTH patients with shock (p = NS).
CONCLUSION
FAST identified abdominal/pelvic hemorrhage in approximately half of NCTH patients, and this was not improved among patients presenting with shock.
背景
在非压缩性躯干出血（NCTH）患者中，超声引导创伤重点评估（FAST）的表现指标尚不清楚。
方法
回顾性分析来自 4 个 1 级创伤中心的专门的 NCTH 数据库（2008-2012 年）。NCTH 的定义为：（1）命名的轴向躯干血管破裂；（2）AIS 胸部或腹部 >2 伴休克（碱缺失< -4）或在≤ 90 分钟内进行躯干手术；或（3）骨盆骨折伴环破裂。患者根据出血源的腔室和休克（SBP≤90）进行分组。
结果
274 例患者在诊断 NCTH 前进行了 FAST。51%的腹部/盆腔出血患者 FAST 阳性，假阴性率（FNR）为 49%。骨盆（61%）来源的 FNR 高于腹部（43%）来源（p=0.02）。对于 ISS、休克、住院时间或死亡率，FAST 阴性或阳性患者之间没有差异（均 p=NS）。在休克的 NCTH 患者亚组中，FNR 没有改善（p=NS）。
结论
FAST 确定了大约一半的 NCTH 患者存在腹部/盆腔出血，而在伴有休克的患者中，这一比例并没有提高。
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