Accuracy of FAST in detecting intraabdominal bleeding in major trauma with pelvic and/or acetabular fractures: a retrospective cohort study
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Accuracy of FAST in detecting intraabdominal bleeding in major trauma with pelvic and/or acetabular fractures : a retrospective cohort study. / Jensen, Lasse Rehné; Possfelt-Møller, Emma; Nielsen, Allan Evald; Singh, Upender Martin; Svendsen, Lars Bo; Penninga, Luit.
I: European Journal of Orthopaedic Surgery and Traumatology, Bind 34, Nr. 3, 2024, s. 1479-1486.Publikation: Bidrag til tidsskrift › Tidsskriftartikel › Forskning › fagfællebedømt
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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 -
ID: 381731232