Hostname: page-component-586b7cd67f-gb8f7 Total loading time: 0 Render date: 2024-11-27T06:06:41.021Z Has data issue: false hasContentIssue false
  • English
  • Français

Focused abdominal ultrasound for blunt trauma in an emergency department without advanced imaging or on-site surgical capability

Published online by Cambridge University Press:  21 May 2015

Michael Shuster ,
Riyad B. Abu-Laban ,
Jeff Boyd ,
Charles Gauthier ,
Sandra Mergler ,
Lance Shepherd  and
Chris Turner
Michael Shuster*
Affiliation:
Department of Emergency Medicine, Mineral Springs Hospital, Banff, Alta
Riyad B. Abu-Laban
Affiliation:
Department of Emergency Medicine and the Centre for Clinical Epidemiology and Evaluation, Vancouver General Hospital, Division of Emergency Medicine, University of British Columbia, Vancouver, BC
Jeff Boyd
Affiliation:
Department of Emergency Medicine, Mineral Springs Hospital, Banff, Alta
Charles Gauthier
Affiliation:
Department of Emergency Medicine, Mineral Springs Hospital, Banff, Alta
Sandra Mergler
Affiliation:
Department of Emergency Medicine, Mineral Springs Hospital, Banff, Alta
Lance Shepherd
Affiliation:
Department of Emergency Medicine, Mineral Springs Hospital, Banff, Alta
Chris Turner
Affiliation:
Department of Emergency Medicine, Mineral Springs Hospital, Banff, Alta
*
Mineral Springs Hospital, Box 1050, Banff AB T1L 1H7; [email protected]

Abstract:

Core share and HTML view are not available for this content. However, as you have access to this content, a full PDF is available via the ‘Save PDF’ action button.
Objectives:

To determine whether focused abdominal sonogram for trauma (FAST) in a rural hospital provides information that prompts immediate transfer to a tertiary care facility for patients with blunt abdominal trauma who would otherwise be discharged or held for observation.

Methods:

Prior to the study, participating emergency physicians underwent a minimum of 30 hours of ultrasound training. All patients who presented with blunt abdominal trauma to our rural hospital between Mar. 1, 2002, and Apr. 30, 2003, were eligible for study. Following a history and physical examination, the emergency physician documented his or her disposition decision. A FAST was then performed, and the disposition reconsidered in light of the FAST results.

Results:

Sixty-seven FAST exams were performed on 65 patients. Three examinations (4.5%) were true-positive (95% confidence interval [CI] 0.9%–12.5%); 60 (89.6%) were true-negative (95% CI 79.7%–95.7%), 4 (6%) were false-negative (95% CI 1.7%–14.6%) and none (0%) were false-positive (95% CI 0%–5.4%). These values reflect sensitivity, specificity, negative predictive value and positive predictive values of 43%, 100%, 94% and 100% respectively. FAST results did not alter the decision to transfer any patient (0%: 95% CI 0.0%–5.4%), although one positive FAST may have led to an expedited transfer. One of 38 patients who was discharged after a negative FAST study returned 24 hours later because of worsening symptoms, and was ultimately found to have splenic and pancreatic injuries.

Conclusions:

This study failed to demonstrate that FAST improves disposition decisions for patients with blunt abdominal trauma who are evaluated in a hospital without advanced imaging or on-site surgical capability. However, the study is not sufficiently powered to rule out a role for FAST in these circumstances, and our data suggest that up to 5.4% of transfer decisions could be influenced by FAST. Rural emergency physicians should not allow a negative FAST study to override a clinical indication for transfer to a trauma centre; however, positive FAST studies can be used to accelerate transfer for definitive treatment.

Keywords

ultrasonographyemergency medicineblunt traumaabdominal injuriesrural hospitals
Type
Em Advances • Innovations en MU
Information
Canadian Journal of Emergency Medicine , Volume 6 , Issue 6 , November 2004 , pp. 408 - 415
Copyright
Copyright © Canadian Association of Emergency Physicians 2004

References

1.Foo, E, Su, JW, Menon, D, Tan, D, Chan, ST.A prospective evaluation of surgeon performed sonography as a screening test in blunt abdominal trauma. Ann Acad Med Singapore 2001;30(1):11–4.Google ScholarPubMed
2.Frezza, EE, Solis, RL, Silich, RJ, Spence, RK, Martin, M.Competency-based instruction to improve the surgical resident technique and accuracy of the trauma ultrasound. Am Surg 1999;65 (9):884–8.CrossRefGoogle ScholarPubMed
3.Ingeman, JE, Plewa, MC, Okasinski, RE, King, RW, Knotts, FB.Emergency physician use of ultrasonography in blunt abdominal trauma. Acad Emerg Med 1996;3(10):931–7.Google Scholar
4.Kern, SJ, Smith, RS, Fry, WR, Helmer, SD, Reed, JA, Chang, FC.Sonographic examination of abdominal trauma by senior surgical residents. Am Surg 1997;63(8):669–74.Google Scholar
5.Ma, OJ, Mateer, JR, Ogata, M, Kefer, MP, Wittmann, D, Aprahamian, C.Prospective analysis of a rapid trauma ultrasound examination performed by emergency physicians. J Trauma 1995; 38(6):879–85.Google ScholarPubMed
6.Mandavia, DP, Aragona, J, Chan, L, Chan, D, Henderson, SO.Ultrasound training for emergency physicians — a prospective study. Acad Emerg Med 2000;7(9):1008–14.CrossRefGoogle ScholarPubMed
7.Smith, RS, Kern, SJ, Fry, WR, Helmer, SD.Institutional learning curve of surgeon-performed trauma ultrasound. Arch Surg 1998; 133(5):530–5; discussion 535–6.CrossRefGoogle ScholarPubMed
8.Lanoix, R, Baker, WE, Mele, JM, Dharmarajan, L.Evaluation of an instructional model for emergency ultrasonography. Acad Emerg Med 1998;5(1):58–63.Google Scholar
9.McCarter, FD, Luchette, FA, Molloy, M, Hurst, JM, Davis K Jr, Johannigman, JA.Institutional and individual learning curves for focused abdominal ultrasound for trauma: cumulative sum analysis. Ann Surg 2000;231(5):689–700.Google Scholar
10.Salen, P, O’Connor, R, Passarello, B, Pancu, D, Melanson, S, Arcona, S, et al. Fast education: a comparison of teaching models for trauma sonography. J Emerg Med 2001;20(4):421–5.Google Scholar
11.Shackford, SR, Rogers, FB, Osler, TM, Trabulsy, ME, Clauss, DW, Vane, DW.Focused abdominal sonogram for trauma: the learning curve of nonradiologist clinicians in detecting hemoperitoneum. J Trauma 1999;46(4):553–62; discussion 562–4.CrossRefGoogle ScholarPubMed
12.Thomas, B, Falcone, RE, Vasquez, D, Pancu, D, Melanson, S, Arcona, S, et al. Ultrasound evaluation of blunt abdominal trauma: program implementation, initial experience, and learning curve. J Trauma 1997;42(3):384–8; discussion 388–90.CrossRefGoogle ScholarPubMed
13.Ballard, RB, Rozycki, GS, Newman, PG, Cubillos, JE, Salomone, JP, Ingram, WL, et al. An algorithm to reduce the incidence of false-negative FAST examinations in patients at high risk for occult injury. Focused Assessment for the Sonographic Examination of the Trauma Patient. J Am Coll Surg 1999;189(2):145–50; discussion 150–1.CrossRefGoogle ScholarPubMed
14.Chiu, WC, Cushing, BM, Rodriguez, A, Ho, SM, Mirvis, SE, Shanmuganathan, K, et al. Abdominal injuries without hemoperitoneum: a potential limitation of focused abdominal sonography for trauma (FAST). J Trauma 1997;42(4):617–23.Google Scholar
15.Coley, BD, Mutabagani, KH, Martin, LC, Zumberge, N, Cooney, DR, Caniano, DA, et al. Focused abdominal sonography for trauma (FAST) in children with blunt abdominal trauma. J Trauma 2000;48(5):902–6.CrossRefGoogle ScholarPubMed
16.Corbett, SW, Andrews, HG, Baker, EM, Jones, WG.ED evaluation of the pediatric trauma patient by ultrasonography. Am J Emerg Med 2000;18(3):244–9.Google Scholar
17.Kirkpatrick, AW, Simons, RK, Brown, DR, Ng, AK, Nicolaou, S.Digital hand-held sonography utilised for the focused assessment with sonography for trauma: a pilot study. Ann Acad Med Singapore 2001;30(6):577–81.Google Scholar
18.McGahan, JP, Rose, J, Coates, TL, Wisner, DH, Newberry, P.Use of ultrasonography in the patient with acute abdominal trauma. J Ultrasound Med 1997;16(10):653–62.Google Scholar
19.McKenney, MG, Martin, L, Lentz, K, Lopez, C, Sleeman, D, Aristide, G, et al. 1,000 consecutive ultrasounds for blunt abdominal trauma. J Trauma 1996;40(4):607–10, discussion 611–2.Google Scholar
20.Mateer, JR, Jehle, D.Ultrasonography in emergency medicine. Acad Emerg Med 1994;1(2):149–52.CrossRefGoogle ScholarPubMed
21.Rozycki, GS, Ballard, RB, Feliciano, DV, Schmidt, JA, Pennington, SD.Surgeon-performed ultrasound for the assessment of truncal injuries: lessons learned from 1540 patients. Ann Surg 1998;228(4):557–67.Google Scholar
22.Yeo, A, Wong, CY, Soo, KC.Focused abdominal sonography for trauma (FAST). Ann Acad Med Singapore 1999;28(6):805–9.Google Scholar
23.Laviolette, E.Need for bedside emergency department ultrasonography: case report of a ruptured ectopic pregnancy. Can J Emerg Med 2004;6(2):112–5.Google Scholar
24.Cardenas, E.Limited bedside ultrasound imaging by emergency medicine physicians. West J Med 1998;168(3):188–9.Google Scholar
25.Heller, M.Emergency ultrasound: out of the acoustic shadows. Ann Emerg Med 1997;29(3):380–2.Google ScholarPubMed
26.Plummer, D.Diagnostic ultrasonography in the emergency department. Ann Emerg Med 1993;22(3):592–4.CrossRefGoogle ScholarPubMed
27.Simon, BC, Snoey, ER.Ultrasound in emergency and ambulatory medicine. St. Louis (MO): Mosby; 1997.Google Scholar
28.Witting, MD, Euerle, BD, Butler, KH.A comparison of emergency medicine ultrasound training with guidelines of the Society for Academic Emergency Medicine. Ann Emerg Med 1999; 34(5):604–9.Google Scholar
29.Bode, PJ, Edwards, MJ, Kruit, MC, van Vugt, AB.Sonography in a clinical algorithm for early evaluation of 1671 patients with blunt abdominal trauma. Am J Roentgenol 1999;172(4):905–11.CrossRefGoogle Scholar
30.Boulanger, BR, McLellan, BA, Brenneman, FD, Ochoa, J, Kirkpatrick, AW.Prospective evidence of the superiority of a sonography-based algorithm in the assessment of blunt abdominal injury. J Trauma 1999;47(4):632–7.Google Scholar
31.Branney, SW, Moore, EE, Cantrill, SV, Burch, JM, Terry, SJ.Ultrasound based key clinical pathway reduces the use of hospital resources for the evaluation of blunt abdominal trauma. J Trauma 1997;42(6):1086–90.CrossRefGoogle ScholarPubMed
32.Godwin, SA.Introduction to emergency ultrasound: a review of justifications, indications and significant findings. Jacksonville Med 1999;50(3).Google Scholar
33.Holm, C, Larsen, MS, Houshian, S, Torfing, T.[Ultrasonographic scanning of patients with severe abdominal injuries.] Ugeskr Laeger 2001;163(43):5967–70.Google ScholarPubMed
34.Ng, A.Trauma ultrasonography: the FAST and beyond. Available: www.trauma.org/radiology/FASTintro.html (accessed 2004 Aug 30).Google Scholar
35.Patel, JC, Tepas, JJ 3rd. The efficacy of focused abdominal sonography for trauma (FAST) as a screening tool in the assessment of injured children. J Pediatr Surg 1999;34(1):44–7.CrossRefGoogle Scholar
36.Rozycki, GS, Shackford, SR.Ultrasound, what every trauma surgeon should know. J Trauma 1996;40(1):1–4.CrossRefGoogle ScholarPubMed
37.Tiling, T, Bouillon, B, Schmid, A.Ultrasound in blunt abdominothoracic trauma. New York (NY): Marcel Dekker; 1990.Google Scholar
38.Jehle, D, Davis, E, Evans, T, Harchelroad, F, Martin, M, Zaiser, K, et al. Emergency department sonography by emergency physicians. Am J Emerg Med 1989;7(6):605–11.Google Scholar
39.Kawaguchi, S, Toyonaga, J, Ikeda, K.Five point method: an ultrasonographic quantification formula of intra-abdominal fluid collection. Japan J Acute Med 1987;7:993–7.Google Scholar
40.Von Kuenssberg Jehle, D, Stiller, G, Wagner, D.Sensitivity in detecting free intraperitoneal fluid with the pelvic views of the FAST exam. Am J Emerg Med 2003;21(6):476–8.Google Scholar