Surgeon-performed ultrasound for the assessment of truncal injuries: Lessons learned from 1540 patients

Grace Rozycki, Robert B. Ballard, David V. Feliciano, Judith A. Schmidt, Scott D. Pennington

Research output: Contribution to journalArticle

Abstract

Objective: To determine the accuracy of the Focused Assessment for the Sonographic examination of the Trauma patient (FAST) when performed by trauma team members during a 3-year period, and to determine the clinical conditions in which the FAST is most accurate in the assessment of injured patients. Summary Background Data: The FAST is a rapid test that sequentially surveys the pericardial region for hemopericardium and then the right and left upper quadrants and pelvis for hemoperitoneum in patients with potential truncal injuries. The clinical conditions in which the FAST is most accurate in the assessment of injured patients have yet to be determined. Methods: FAST examinations were performed on patients with precordial or transthoracic wounds or blunt abdominal trauma. Patients with a positive ultrasound (US) examination for hemopericardium underwent immediate surgery, whereas those with a positive US for hemoperitoneum underwent a computed tomography scan (if they were hemodynamically stable) or immediate celiotomy (if they were hemodynamically unstable-blood pressure ≤ 90 mmHg). Results: FAST examinations were performed in 1540 patients (1227 with blunt injuries, 313 with penetrating injuries). There were 1440 true-negative results, 80 true- positive results, 16 false-negative results, and 4 false-positive results; the sensitivity was 83.3%, the specificity 99.7%. US was most sensitive and specific for the evaluation of patients with precordial or transthoracic wounds (sensitivity 100%, specificity 99.3%) and hypotensive patients with blunt abdominal trauma (sensitivity 100%, specificity 100%). Conclusions: US should be the initial diagnostic modality for the evaluation of patients with precordial wounds and blunt truncal injuries because it is rapid and accurate. Because of the high sensitivity and specificity of US in the evaluation of patients with precordial wounds and hypotensive patients with blunt torso trauma, immediate surgical intervention is justified when those patients have a positive US examination.

Original languageEnglish (US)
Pages (from-to)557-567
Number of pages11
JournalAnnals of surgery
Volume228
Issue number4
DOIs
StatePublished - Oct 1 1998
Externally publishedYes

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Wounds and Injuries
Hemoperitoneum
Nonpenetrating Wounds
Pericardial Effusion
Sensitivity and Specificity
Surgeons
Torso
Pelvis
Tomography
Blood Pressure

ASJC Scopus subject areas

  • Surgery

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Surgeon-performed ultrasound for the assessment of truncal injuries : Lessons learned from 1540 patients. / Rozycki, Grace; Ballard, Robert B.; Feliciano, David V.; Schmidt, Judith A.; Pennington, Scott D.

In: Annals of surgery, Vol. 228, No. 4, 01.10.1998, p. 557-567.

Research output: Contribution to journalArticle

Rozycki, Grace ; Ballard, Robert B. ; Feliciano, David V. ; Schmidt, Judith A. ; Pennington, Scott D. / Surgeon-performed ultrasound for the assessment of truncal injuries : Lessons learned from 1540 patients. In: Annals of surgery. 1998 ; Vol. 228, No. 4. pp. 557-567.
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abstract = "Objective: To determine the accuracy of the Focused Assessment for the Sonographic examination of the Trauma patient (FAST) when performed by trauma team members during a 3-year period, and to determine the clinical conditions in which the FAST is most accurate in the assessment of injured patients. Summary Background Data: The FAST is a rapid test that sequentially surveys the pericardial region for hemopericardium and then the right and left upper quadrants and pelvis for hemoperitoneum in patients with potential truncal injuries. The clinical conditions in which the FAST is most accurate in the assessment of injured patients have yet to be determined. Methods: FAST examinations were performed on patients with precordial or transthoracic wounds or blunt abdominal trauma. Patients with a positive ultrasound (US) examination for hemopericardium underwent immediate surgery, whereas those with a positive US for hemoperitoneum underwent a computed tomography scan (if they were hemodynamically stable) or immediate celiotomy (if they were hemodynamically unstable-blood pressure ≤ 90 mmHg). Results: FAST examinations were performed in 1540 patients (1227 with blunt injuries, 313 with penetrating injuries). There were 1440 true-negative results, 80 true- positive results, 16 false-negative results, and 4 false-positive results; the sensitivity was 83.3{\%}, the specificity 99.7{\%}. US was most sensitive and specific for the evaluation of patients with precordial or transthoracic wounds (sensitivity 100{\%}, specificity 99.3{\%}) and hypotensive patients with blunt abdominal trauma (sensitivity 100{\%}, specificity 100{\%}). Conclusions: US should be the initial diagnostic modality for the evaluation of patients with precordial wounds and blunt truncal injuries because it is rapid and accurate. Because of the high sensitivity and specificity of US in the evaluation of patients with precordial wounds and hypotensive patients with blunt torso trauma, immediate surgical intervention is justified when those patients have a positive US examination.",
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