Woo S Do, MD1, Matthew J Eckert, MD1, Ronald Chang, MD2, Erin E Fox, PhD2, Charles E Wade, PhD2, John B Holcomb2, Matthew J Martin1. 1Legacy Emmanuel Medical Center, Portland, OR, 2Center for Translational Injury Research, University of Texas Health Science Center, Houston, TX
Objectives: Trauma surgeons assessing patients with non-compressible torso hemorrhage (NCTH) often rely on the focused assessment with sonography for trauma (FAST) as an initial point of care imaging study. The objective of this study was to describe the metrics of FAST as a stand-alone study in a large cohort with NCTH.
Methods: Retrospective review of a dedicated NCTH database from four level 1 trauma centers (2008-2012). NCTH was defined as (1) named axial torso vessel disruption; (2) AIS chest or abdomen >2 with shock (base deficit <-4) or truncal operation in <=90 minutes; or (3) pelvic fracture with ring disruption. Patients were grouped by anatomic location of primary source of hemorrhage (abdomen vs. pelvis) and by hemodynamic instability (SBP <=90).
Results: 274 patients had a FAST exam prior to diagnosis of NCTH (50% by operative exploration, 28% by CTA, 19% by angiography). The source of NCTH was thoracic in 84 patients, abdominal in 119, and pelvic in 71. The FAST was positive in only 51% of patients with abdominal or pelvic hemorrhage for an overall false negative rate of 49%. The false negative rate was significantly higher for pelvic (61%) versus abdominal (43%) sources (p=0.02). There was no difference between FAST negative or positive patients for ISS, shock, length of stay, or mortality (all p=NS). FAST performance metrics were not improved among the subgroup of NCTH patients with hemodynamic instability at presentation (p=NS). In addition, the false negative rates among those requiring laparotomy for hemorrhage control were 41% (abdominal) and 36% (pelvic).
Conclusion: The initial FAST exam identified abdominal or pelvic hemorrhage in approximately half of NCTH patients, and this was not significantly improved among NCTH patients presenting with hemodynamic instability. The high false negative rate, particularly for pelvic sources, must be considered when interpreting and acting on this study.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 86400
Program Number: MSS16
Presentation Session: Full-Day Military Surgical Symposium – Trauma/Critical Care Presentations
Presentation Type: MSSPodium
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