Alramdan Mohammed H A, Yakar Derya, IJpma Frank F A, Kasalak Ömer, Kwee Thomas C
Medical Imaging Center, Department of Radiology, Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Center Groningen, Hanzeplein 1, P.O. Box 30.001, 9700 RB, Groningen, The Netherlands.
Department of Trauma Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
Insights Imaging. 2020 Sep 23;11(1):102. doi: 10.1186/s13244-020-00911-5.
To investigate if patients with confirmed traumatic abdominal injury and a false-negative focused abdominal sonography for trauma (FAST) examination have a more favorable prognosis than those with a true-positive FAST.
This study included 97 consecutive patients with confirmed traumatic abdominal injury (based on computed tomography [CT] and/or surgical findings) who underwent FAST.
FAST was false-negative in 40 patients (41.2%) and true-positive in 57 patients (58.8%). Twenty-two patients (22.7%) had an unfavorable outcome (defined as the need for an interventional radiologic procedure, laparotomy, or death due to abdominal injury). Univariately, a false-negative FAST (odds ratio [OR] 0.24; p = 0.017) and a higher systolic blood pressure (OR, 0.97 per mmHg increase; p = 0.034) were significantly associated with a favorable outcome, whereas contrast extravasation on CT (OR, 7.17; p = 0.001) and shock index classification (OR, 1.89 for each higher class; p = 0.046) were significantly associated with an unfavorable outcome. Multivariately, only contrast extravasation on CT remained significantly associated with an unfavorable outcome (OR, 4.64; p = 0.016). When excluding contrast extravasation on CT from multivariate analysis, only a false-negative FAST result was predictive of a favorable outcome (OR, 0.28; p = 0.038).
Trauma patients with confirmed abdominal injury and a false-negative FAST have a better outcome than those with a positive FAST. FAST may be valuable for risk stratification and prognostication in patients with a high suspicion of abdominal injury when CT has not been performed yet or when CT is not available.
探讨确诊为创伤性腹部损伤且创伤重点超声检查（FAST）结果为假阴性的患者，其预后是否比FAST结果为真阳性的患者更好。
本研究纳入了97例连续确诊为创伤性腹部损伤（基于计算机断层扫描[CT]和/或手术结果）并接受FAST检查的患者。
40例患者（41.2%）的FAST结果为假阴性，57例患者（58.8%）为真阳性。22例患者（22.7%）预后不良（定义为需要进行介入放射学操作、剖腹手术或因腹部损伤死亡）。单因素分析显示，FAST结果为假阴性（比值比[OR]为0.24；p = 0.017）和收缩压较高（OR为每增加1 mmHg，0.97；p = 0.034）与良好预后显著相关，而CT上的造影剂外渗（OR为7.17；p = 0.001）和休克指数分级（每升高一级OR为1.89；p = 0.046）与不良预后显著相关。多因素分析显示，只有CT上的造影剂外渗仍与不良预后显著相关（OR为4.64；p = 0.016）。从多因素分析中排除CT上的造影剂外渗后，只有FAST结果为假阴性可预测良好预后（OR为0.28；p = 0.038）。
确诊为腹部损伤且FAST结果为假阴性的创伤患者，其预后比FAST结果为阳性的患者更好。当尚未进行CT检查或无法进行CT检查时，FAST对于高度怀疑腹部损伤的患者进行风险分层和预后评估可能具有重要价值。
