The Blunt Abdominal Trauma Bedside Ultrasonography Comparison with Trauma Severity Scores and Computerized Tomography

Abstract

Objective: To investigate the accuracy of focussed assessment sonography for trauma (FAST) bedside ultrasonography application in patients with blunt abdominal trauma and patient management, clinical outcome, and trauma severity scores.

Study design: Cross-sectional descriptive study.

Place and duration of study: Department of Emergency Medicine, Ondokuz Mayis University, Faculty of Medicine, Samsun, Turkey, from April 2013 to June 2017.

Methodology: The presence of intraperitoneal free fluid (FF) was investigated by FAST application by emergency physicians. Abdominal computed tomography (CT), which was considered the gold standard, was made use of for evaluating intraperitoneal FF presence. Patients were evaluated for urgent surgical intervention, requirement of blood transfusion, and mortality status. The relationship between the FF presence / absence in FAST practice and revised trauma score (RTS), injury severity score (ISS) and trauma injury severity score (TRISS) was statistically analysed.

Results: All 28 FAST (+) patients also had intraperitoneal FF in gold standart CT. Although the gold standart CT detected intraperitoneal FF in 6 (4.2%) of 140 FAST (-) patients, the compatibility between FAST and CT in the detection of intraperitoneal FF in patients with blunt abdominal trauma was statistically significant (k: 0.882, p<0.001). RTS and ISS scores were 6.24 ± 1.74 and 44.0 ± 15.7 in eleven (3.5%) dead patients. The sensitivity, specificity, positive predictive value, and negative predictive value were found to be 82.3% (95% CI: 65.4-93.2), 100% (95% CI: 97.2-100), 100% and 95.7% (95% CI: 91.5-97.8), respectively.

Conclusion: FAST had a high accuracy compared to gold standard CT in detecting FF. Low RTS and high ISS are associated with impaired hemodynamic parameters and detected FF [FAST (+)].