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

Research output: Contribution to journalArticle

76 Citations (Scopus)

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
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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Abdominal Injuries
Wounds and Injuries
Hemoperitoneum
Emergency Medicine
Trauma Centers
Internship and Residency
Abdomen
Observational Studies
Prospective Studies
Population

Keywords

  • Ultrasound Blunt Abdominal Trauma Prospective study

ASJC Scopus subject areas

  • Surgery

Cite this

Secondary ultrasound examination increases the sensitivity of the FAST exam in blunt trauma. / Blackbourne, Lorne H.; Soffer, Dror; McKenney, Mark; Amortegui, Jose; Schulman, Carl I; Crookes, Bruce; Habib, Fahim; Benjamin, Robert; Lopez, Peter P.; Namias, Nicholas; Lynn, Mauricio; Cohn, Stephen M.

In: Journal of Trauma - Injury, Infection and Critical Care, Vol. 57, No. 5, 01.11.2004, p. 934-938.

Research output: Contribution to journalArticle

Blackbourne, Lorne H. ; Soffer, Dror ; McKenney, Mark ; Amortegui, Jose ; Schulman, Carl I ; Crookes, Bruce ; Habib, Fahim ; Benjamin, Robert ; Lopez, Peter P. ; Namias, Nicholas ; Lynn, Mauricio ; Cohn, Stephen M. / Secondary ultrasound examination increases the sensitivity of the FAST exam in blunt trauma. In: Journal of Trauma - Injury, Infection and Critical Care. 2004 ; Vol. 57, No. 5. pp. 934-938.
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AU - Soffer, Dror

AU - McKenney, Mark

AU - Amortegui, Jose

AU - Schulman, Carl I

AU - Crookes, Bruce

AU - Habib, Fahim

AU - Benjamin, Robert

AU - Lopez, Peter P.

AU - Namias, Nicholas

AU - Lynn, Mauricio

AU - Cohn, Stephen M.

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N2 - 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.

AB - 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.

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