Secondary ultrasound examination increases the sensitivity of the FAST exam in blunt trauma

Lorne H. Blackbourne, Dror Soffer, Mark McKenney, Jose Amortegui, Carl I. Schulman, Bruce Crookes, Fahim Habib, Robert Benjamin, Peter P. Lopez, Nicholas Namias, Mauricio Lynn, Stephen M. Cohn

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80 Scopus citations

Abstract

Introduction: Approximately one third of stable patients with significant intra-abdominal injury do not have significant intraperitoneal blood evident on admission. We hypothesized that a delayed, repeat ultrasound study (Secondary Ultrasound - SUS) will reveal additional intra-abdominal injuries and hemoperitoneum. Methods: We performed a prospective observational study of trauma patients at our Level I trauma center from April 2003 to December 2003. Patients underwent an initial ultrasound (US), followed by a SUS examination within 24 hours of admission. Patients not eligible for a SUS because of early discharge, operative intervention or death were excluded. All US and SUS exams were performed and evaluated by surgical/emergency medicine house staff or surgical attendings. Results: Five hundred forty-seven patients had both an initial US and a SUS examination. The sensitivity of the initial US in this patient population was 31.1% and increased to 72.1% on SUS (p < 0.001) for intra-abdominal injury or intra-abdominal fluid. The specificity for the initial US was 99.8% and 99.8% for SUS. The negative predictive value was 92.0% for the initial US and increased to 96.6% for SUS (p = 0.002). The accuracy of the initial ultrasound was 92.1% and increased to 96.7% on the SUS (p < 0.002). No patient with a negative SUS after 4 hours developed clinically significant hemoperitoneum. Conclusion: A secondary ultrasound of the abdomen significantly increases the sensitivity of ultrasound to detect intra-abdominal injury.

Original languageEnglish (US)
Pages (from-to)934-938
Number of pages5
JournalJournal of Trauma - Injury, Infection and Critical Care
Volume57
Issue number5
DOIs
StatePublished - Nov 1 2004
Externally publishedYes

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Keywords

  • Ultrasound Blunt Abdominal Trauma Prospective study

ASJC Scopus subject areas

  • Surgery

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