Table of Content Volume 11 Issue 1 - July 2019

 

 

A study of diagnostic efficacy of fast in blunt abdominal trauma

 

Anil Baliram Bonde¹, Vinod Narayanrao Chaudhari^2*

 

Abstract               Background: Blunt abdominal trauma is a leading cause of both morbidity and mortality in patients in the emergency department. Aims and Objectives: Study of Diagnostic Efficacy of FAST in Blunt Abdominal Trauma Methodology: This was a cross-sectional study at Radiology department of tertiary health care center. All the Patients of All age group referred from Surgery department with blunt trauma was included into study. All the patients first evaluated by FAST and later on confirmed by Laparotomy Results. Here the Diagnostic efficacy of FAST Calculated by Sensitivity, Specificity, PPV and NPV. Result: In our study we found that The majority of the patients were from the age group of >60 -29.41% followed by 50-60 19.60%-40-50-17.64% ; 30-40-15.68%; 10-20-9.80%; 20-30-7.84%.The majority of the Patients were Male i.e. 66.67% as compared to Females 33.33%.The sensitivity of FAST was 87.50% and Specificity was 94.73% and Positive Predictive values were 96.55% and Negative Predictive value 81.81%. Conclusion: The usefulness and Diagnostic efficacy of FAST is very high as in our study sensitivity of FAST was 87.50% and Specificity was 94.73% and Positive Predictive values were 96.55% and Negative Predictive value 81.81%. So FAST is easy and Bedside test and useful for early theurapticintervention.

Key Word: FAST, Blunt Abdominal Trauma

 

 

 

INTRODUCTION

Blunt abdominal trauma is a leading cause of both morbidity and mortality in patients in the emergency department.¹ A retrospective study by Schurink et al in 1997 showed that abdominal examination produced equivocal results in nearly half the patients with multiple injured trauma patients.²Multi-slice CT scans can produce very detailed images, are noninvasive and have become the gold standard investigation in assessing blunt abdominal trauma. With the development of helical CT, the scan time has been significantly reduced, improving its usefulness with a sensitivity and specificity of over 95% in detecting intra-abdominal injury and a high negative predictive value of nearly 100%.³ It is also useful for localising, identifying and assessing severity of solid organ injury helping guide the non operative management or surgical planning.⁴ The need for a prompt diagnostic technique that could be used in the emergency setting led to the introduction of focused assessment with sonography in trauma (FAST) in emergency departments in the 1990’s. It is undertaken after the primary survey in order to identify the presence of free fluid in the peritoneal cavity, which may represent haemoperitoneum, and thus enable early referral for further imaging (CT), and/or surgery if necessary.¹ Studies have shown that FAST can pick up as little as 100 ml of free fluid, characterised by low echogenicity which appears black on screen, or blood which is of increased echogenicity.⁵ There is some evidence to suggest it can detect as little as 30 ml of free fluid, but 100 ml is generally considered to be the level at which FAST scanning is accurate.⁶ Knowing that a patient has free fluid suggests the possibility of severe intra-peritoneal haemorrhage and supports the case for further management, such as an emergency CT and/or surgery. Haemodynamically stable patients may be sent for CT scanning in order to assess the origin and extent of injury so as to achieve prompt and appropriate management, whilst haemodynamically unstable patients may be taken directly to the operating theatre for emergency laparotomy where a lack of formal, comprehensive imaging could potentially lengthen the theatre time as the site and extent of injury is unknown. Unlike FAST scan, CT’s are able to detect solid organ injury, however a large study by Fakhry et al in 2003 showed that nearly 15% of patients with perforated small bowel injury had a normal pre-operative CT scan so they are not without limitation.⁷In unstable patients where time is critical, ultrasound is quick and can be done at the bedside, several observational studies have shown its utility as a screening test in this setting.^{8, 9}.

 

AIMS AND OBJECTIVES

Study of Diagnostic Efficacy of FAST in Blunt Abdominal Trauma

 

METHODOLOGY

This was a cross-sectional study at Radiology department of tertiary health care center. All the Patients of All age group referred from Surgery department with blunt trauma were included into study.All the patients first evaluated by FAST and later on confirmed by Laparotomy Results. Here the Diagnostic efficacy of FAST Calculated by Sensitivity, Specificity, PPV and NPV.

RESULT

Table 1 : Age wise distribution of the Patients

The majority of the patients were from the age group of >60 -29.41% followed by 50-60 19.60%-40-50-17.64% ; 30-40-15.68%; 10-20-9.80%; 20-30-7.84%.

 

Table 2: Gender wise distribution of the Patients

The majority of the Patients were Male i.e. 66.67% as compared to Females 33.33%.

Table 3: Comparative of FAST results with laparotomy finding

The sensitivity of FAST was 87.50% and Specificity was 94.73% and Positive Predictive values were 96.55% and Negative Predictive value 81.81%.

 

DISCUSSION

US is a good modality in the trauma setting because examinations can be performed quickly at a patient’s bedside, the US scanner is portable, and US is highly sensitive to the presence of free peritoneal fluid ¹⁰. However, since US is not sensitive for the detection of parenchymal lesions and because hemoperitoneum is not always present in patients with solid organ injuries, US is not a reliable method for use in the exclusion of abdominal lesions ¹². Taylor and Sivit¹¹ discussed this drawback and reported that screening US for blunt abdominal trauma should be approached with caution. In their large cohort study, they noted the absence of peritoneal fluid in 37% of children with intraabdominal injuries, and they emphasized the limited importance of peritoneal fluid as a predictor of the need for laparotomy. Emery et al ¹³ reached the same conclusions when they found that 34% of children with normal findings at screening US had an intraabdominal injury at CT. Benya et al ¹⁴ concluded their prospective study by suggesting that normal US findings failed to ensure the absence of intraabdominal injury, and, therefore, US was not adequately helpful to the pediatric trauma surgeon when treatment had to be planned. However, the accurate assessment of parenchymal findings in lesions (extension, presence of hematoma, vascular injuries, etc) is particularly important in children, as nonsurgical treatment has long been the accepted strategy for the care of hemodynamicallystable pediatric patients¹⁵. In our study we found that The majority of the patients were from the age group of >60 -29.41% followed by 50-60 19.60%-40-50-17.64%; 30-40-15.68%; 10-20-9.80%; 20-30-7.84%. The majority of the Patients were Male i.e. 66.67% as compared to Females 33.33%.The sensitivity of FAST was 87.50% and Specificity was 94.73% and Positive Predictive values were 96.55% and Negative Predictive value 81.81%.

 

CONCLUSION

The usefulness and Diagnostic efficacy of FAST is very high as in our study sensitivity of FAST was 87.50% and Specificity was 94.73% and Positive Predictive values were 96.55% and Negative Predictive value 81.81%.So FAST is easy and Bedside test and useful for early theurapticintervention.

 

REFERENCES