The focused assessment with sonography in trauma (FAST) in hypotensive injured patients frequently fails to identify the need for laparotomy: a multi-institutional pragmatic study

Trauma Surgery & Acute Care Open
Susan E RowellMartin A Schreiber

Abstract

The ability of focused assessment with sonography for trauma (FAST) to detect clinically significant hemorrhage in hypotensive injured patients remains unclear. We sought to describe the sensitivity and specificity of FAST using findings at laparotomy as the confirmatory test. Patients from the Prospective Observational Multicenter Major Trauma Transfusion (PROMMTT) study that had a systolic blood pressure < 90mm Hg and underwent FAST were analysed. Results were compared with findings at laparotomy. A therapeutic laparotomy (T-LAP) was defined as an abdominal operation within 6 hours in which a definitive procedure was performed. The sensitivity and specificity of FAST were calculated. The cohort included 317 patients that underwent FAST (108 positive, 209 negative). T-LAP was performed in 69% (n=75) of FAST(+) patients and 22% (n=48) of FAST(-) patients. FAST had a sensitivity of 62% and specificity of 83%. In our multicenter cohort, 22% of FAST(-) patients underwent T-LAP within 6 hours of admission. In hypotensive patients with a negative FAST, clinicians should still maintain a high index of suspicion for significant abdominal hemorrhage. Level IV.

References

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Citations

Oct 3, 2020·JBJS Reviews·Jillian M KazleyCory M Czajka
Jan 25, 2021·European Journal of Trauma and Emergency Surgery : Official Publication of the European Trauma Society·Itamar AshkenaziFernando Turégano Fuentes
Nov 13, 2021·Journal of Trauma Nursing : the Official Journal of the Society of Trauma Nurses·Darcy L DayMichael S Hayashi

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Methods Mentioned

BETA
lavage
ISS

Software Mentioned

FAST
PROMMTT

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