Division of Acute Care Surgery, LAC+USC Medical Center, University of Southern California, 2051 Marengo Street, Inpatient Tower (C), C5L100, Los Angeles, CA, 90033, USA.
World J Surg. 2022 Jan;46(1):91-97. doi: 10.1007/s00268-021-06317-8. Epub 2021 Sep 22.
In patients undergoing resuscitative thoracotomy (RT) for traumatic cardiac arrest, focused assessment with sonography for trauma (FAST) is often used to look for intraperitoneal fluid. These findings can help determine whether abdominal exploration is warranted once return of spontaneous circulation is achieved; however, the diagnostic accuracy of FAST in this clinical scenario has yet to be evaluated. The purpose of this study was to assess the performance of FAST in identifying intra-abdominal hemorrhage following RT.
We performed a 3-year retrospective study at a high-volume level 1 trauma center from 2014 to 2016. We included patients who underwent RT in the Emergency Department. All FAST examinations were performed by non-radiologists. Operative findings, computed tomography reports, diagnostic peritoneal aspirate (DPA) results, and autopsy findings were used as reference standards to calculate the sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy of the FAST.
A total of 158 patients met our inclusion criteria. The median age was 35 years (interquartile range [IQR]: 23-53), 86.1% were male, and 60.1% sustained blunt trauma. Most patients suffered severe injuries with a median injury severity score of 27 (IQR: 18-38). The sensitivity, specificity, PPV, NPV, and accuracy of FAST for identifying intra-abdominal hemorrhage were 66.0%, 84.8%, 68.6%, 83.2%, and 78.5%, respectively. Among the 107 patients with a negative FAST, 22 (20.6%) underwent DPA, which was positive in 5 patients.
FAST can be utilized in the diagnostic workup of trauma patients after RT. In patients with a positive FAST, exploratory laparotomy is warranted, whereas other diagnostic adjuncts such as DPA or mandatory abdominal exploration may be considered in patients with a negative FAST.
在因创伤导致心搏骤停而接受抢救性开胸术（RT）的患者中，通常会使用创伤超声重点评估（FAST）来寻找腹腔内液体。这些发现有助于确定一旦自主循环恢复，是否需要进行剖腹探查；然而，FAST 在这种临床情况下的诊断准确性尚未得到评估。本研究的目的是评估 FAST 在识别 RT 后腹腔内出血方面的表现。
我们在 2014 年至 2016 年期间在一家高容量 1 级创伤中心进行了为期 3 年的回顾性研究。我们纳入了在急诊科接受 RT 的患者。所有 FAST 检查均由非放射科医生进行。手术发现、计算机断层扫描报告、诊断性腹腔穿刺（DPA）结果和尸检结果被用作参考标准，以计算 FAST 的敏感性、特异性、阳性预测值（PPV）、阴性预测值（NPV）和准确性。
共有 158 名患者符合纳入标准。中位年龄为 35 岁（四分位距 [IQR]：23-53），86.1%为男性，60.1%遭受钝性创伤。大多数患者遭受严重损伤，损伤严重程度评分中位数为 27（IQR：18-38）。FAST 识别腹腔内出血的敏感性、特异性、PPV、NPV 和准确性分别为 66.0%、84.8%、68.6%、83.2%和 78.5%。在 107 名 FAST 阴性的患者中，有 22 名（20.6%）进行了 DPA，其中 5 名阳性。
FAST 可用于 RT 后创伤患者的诊断性检查。在 FAST 阳性的患者中，需要进行剖腹探查，而在 FAST 阴性的患者中，可以考虑其他诊断辅助手段，如 DPA 或强制性剖腹探查。
