TY - JOUR

T1 - Accuracy of FAST in detecting intraabdominal bleeding in major trauma with pelvic and/or acetabular fractures

T2 - a retrospective cohort study

AU - Jensen, Lasse Rehné

AU - Possfelt-Møller, Emma

AU - Nielsen, Allan Evald

AU - Singh, Upender Martin

AU - Svendsen, Lars Bo

AU - Penninga, Luit

N1 - Publisher Copyright: © 2024, The Author(s).

PY - 2024

Y1 - 2024

N2 - Purpose: The Focused Assessment with Sonography for Trauma (FAST) is a tool to rapidly detect intraabdominal and intrapericardial fluid with point-of-care ultrasound. Previous studies have questioned the role of FAST in patients with pelvic fractures. The aim of the present study was to assess the accuracy of FAST to detect clinically significant intraabdominal hemorrhage in patients with pelvic fractures. Methods: We included all consecutive patients with pelvic and/or acetabular fractures treated our Level 1 trauma center from 2009–2020. We registered patient and fracture characteristics, FAST investigations and CT descriptions, explorative laparotomy findings, and transfusion needs. We compared FAST to CT and laparotomy findings, and calculated true positive and negative findings, sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV). Results: We included 389 patients. FAST had a sensitivity of 75%, a specificity of 98%, a PPV of 84%, and a NPV of 96% for clinically significant intraabdominal bleeding. Patients with retroperitoneal hematomas were at increased risk for laparotomy both because of True-negative FAST and False-positive FAST. Conclusion: FAST is accurate to identify clinically significant intraabdominal blood in patients with severe pelvic fractures and should be a standard asset in these patients. Retroperitoneal hematomas challenge the FAST interpretation and thus the decision making when applying FAST in patients with pelvic fractures.

AB - Purpose: The Focused Assessment with Sonography for Trauma (FAST) is a tool to rapidly detect intraabdominal and intrapericardial fluid with point-of-care ultrasound. Previous studies have questioned the role of FAST in patients with pelvic fractures. The aim of the present study was to assess the accuracy of FAST to detect clinically significant intraabdominal hemorrhage in patients with pelvic fractures. Methods: We included all consecutive patients with pelvic and/or acetabular fractures treated our Level 1 trauma center from 2009–2020. We registered patient and fracture characteristics, FAST investigations and CT descriptions, explorative laparotomy findings, and transfusion needs. We compared FAST to CT and laparotomy findings, and calculated true positive and negative findings, sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV). Results: We included 389 patients. FAST had a sensitivity of 75%, a specificity of 98%, a PPV of 84%, and a NPV of 96% for clinically significant intraabdominal bleeding. Patients with retroperitoneal hematomas were at increased risk for laparotomy both because of True-negative FAST and False-positive FAST. Conclusion: FAST is accurate to identify clinically significant intraabdominal blood in patients with severe pelvic fractures and should be a standard asset in these patients. Retroperitoneal hematomas challenge the FAST interpretation and thus the decision making when applying FAST in patients with pelvic fractures.

KW - Bleeding

KW - FAST

KW - Laparotomy

KW - Pelvic Fractures

KW - Transfusions

U2 - 10.1007/s00590-023-03813-6

DO - 10.1007/s00590-023-03813-6

M3 - Journal article

C2 - 38253932

AN - SCOPUS:85182840964

VL - 34

SP - 1479

EP - 1486

JO - European Journal of Orthopaedic Surgery and Traumatology

JF - European Journal of Orthopaedic Surgery and Traumatology

SN - 1633-8065

IS - 3

ER -