Focused abdominal sonography for trauma in the emergency department for blunt abdominal trauma

• Published in: International journal of emergency medicine Vol. 1; no. 3; pp. 183 - 187
• Main Authors: Tsui, Chi Leung, Fung, Hin Tat, Chung, Kin Lai, Kam, Chak Wah
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01.09.2008; Springer Nature B.V; Springer-Verlag
• Subjects: Abdomen; Angiology; Breast cancer; Cardiology; Emergency medical care; Emergency Medicine; Internal Medicine; Medicine; Medicine & Public Health; Original; Original Article; Pediatrics; Performance evaluation; Trauma; Ultrasonic imaging; Hong Kong China; China; FAST; Ultrasound; Emergency medicine; Blunt abdominal injury
• ISSN: 1865-1372; 1865-1380; 1865-1380
• DOI: 10.1007/s12245-008-0050-2

Background Blunt abdominal trauma (BAT) is a diagnostic challenge to the emergency physician (EP). The introduction of bedside ultrasound provides another diagnostic tool for the EP to detect intra-abdominal injuries. Aims To evaluate the performance of EP in a local emergency department in Hong Kong to perform the ‘focused abdominal sonography for trauma’ (FAST) in BAT patients. Methods This was a retrospective cohort study including all the trauma team cases in a 36-month period in the emergency department of a public hospital in Hong Kong. The results of FAST scans were analyzed and compared with CT scans when the FAST was positive or followed by a period of clinical observation when the FAST was negative. Descriptive statistics and sensitivity, specificity, and predictive values were calculated. Results There was a total of 273 cases, and FAST scans were performed in 242 cases. The sensitivity and specificity were 86% and 99%, respectively. The negative predictive value was 0.98, while the positive predictive value was 0.94. The overall accuracy was 97%. Conclusions The performance of the EP in using FAST scans in BAT patients was encouraging. The high specificity (99%), positive predictive value (0.98), and likelihood ratio for positive tests (86) make it a good ‘rule in’ tool for BAT patients. The high negative predictive value also makes the FAST scan a useful screening tool. However, ultrasound examination is operator dependent, and FAST scan has its own limitations. For negative FAST scan cases, we recommend a period of monitoring, serial FAST scans, or further investigations, such as CT scan or peritoneal lavage.