The Effectiveness of Focused Assessment With Sonography for Trauma in Evaluating Blunt Abdominal Trauma With a Seatbelt Mark Sign

Abstract

Background: Specific injury patterns have been recognized from seatbelt use including hollow viscous, mesenteric, and musculoskeletal injuries. We aimed to evaluate if focused assessment with sonography for trauma (FAST) is a reliable screening tool for the initial evaluation of the blunt abdominal trauma patient with a seatbelt sign.

Methods: A retrospective review of adult trauma patients with blunt abdominal trauma and a positive seatbelt sign were evaluated over a three-year period. Data collected included age, gender, Glasgow coma scale (GCS), presence or absence of abdominal tenderness, results of diagnostic studies, operative findings, missed injuries, and mortality.

Results: A total of sixty-nine patients were evaluated. Fifty-eight ultrasound scans were interpreted as negative and 11 positive. Three of the 11 were taken immediately to the operating room. The remaining 8 underwent computerized tomography (CT) according to protocol and clinical management was altered in two. Sixteen patients with a negative ultrasound examination underwent CT. Our series revealed 11 true and no false positives, as well as 54 true and 4 false negatives. The sensitivity of utilizing FAST for detecting a clinically significant injury in this study is 73% with 100% specificity, a negative predictive value of 93%, positive predictive value of 100%, and accuracy of 94%.

Conclusions: The use of FAST, not as a single diagnostic modality, but as a screening tool with selective use of CT, is a relatively reliable instrument for the initial evaluation of the blunt abdominal trauma patient with a seatbelt mark sign.




J Curr Surg. 2014;4(1):17-22
doi: http://dx.doi.org/10.14740/jcs207w