FAST versus CT for detecting intra-abdominal injury in hemodynamically stable patients after motor vehicle collisions: a systematic review
DOI:
https://doi.org/10.65759/m7sebe16Keywords:
Intra-abdominal injury, FAST, CT, Motor vehicle collisionsAbstract
Background: In hemodynamically stable patients after motor vehicle collisions (MVCs), rapid detection of intra-abdominal injury (IAI) is important to avoid missed injuries. FAST (Focused Assessment with Sonography for Trauma) is a widely used method for bedside screening, and computed tomography (CT) is the principal for evaluation. We aimed to systematically review the data comparing FAST with CT for detection of IAI in hemodynamically stable patients after MVC related blunt abdominal trauma. Methods: our study is A PRISMA based systematic review and our literature search was applied in PubMed, Scopus, and Web of Science. We screened free original studies about FAST in blunt abdominal trauma, with CT and clinical reference standards. A set of 10 original studies were included, cohorts focused on hemodynamically stable blunt trauma and motor vehicle accident populations. Data extraction was done and we extract the study design, population characteristics, hemodynamic status, comparator standard, and diagnostic outcomes. Results: The identified studies were heterogeneous in design, trauma mechanism, age group, and outcome definitions. FAST show a value as a rapid bedside triage tool, but limitations were noted in excluding all IAIs, mainly low volume bleeding and gastrointestinal injuries. CT is the most comprehensive modality for injury detection and characterization in stable patients. Conclusion: FAST is complementary early assessment tool rather than a standard substitute for CT in hemodynamically stable MVC patients with suspected IAI.
References
American College of Radiology (ACR). ACR Appropriateness Criteria® Major Blunt Trauma Reston (VA): American College of Radiology; 2023. Available from: ACR Appropriateness Criteria narrative/literature search pages.
Ben-Ishay O, Daoud M, Peled Z, Brauner E, Abu-Kishk I, Ashkenazi I, et al. Focused abdominal sonography for trauma in the clinical evaluation of children with blunt abdominal trauma. World J Emerg Surg. 2015;10:27. PMID: 26155302.
Dammers D, El Moumni M, Hoogland IIL, Veeger N, ter Avest E. Should we perform a FAST exam in haemodynamically stable patients presenting after blunt abdominal injury: a retrospective cohort study. Scand J Trauma Resusc Emerg Med. 2017;25(1):1. doi:10.1186/s13049-016-0342-0. PMID: 28049498; PMCID: PMC5210260.
Desai N, Harris T. Extended focused assessment with sonography in trauma. BJA Educ. 2021;21(2):54-61. PMID: 33456811; PMCID: PMC7807983.
Deunk J, Brink M, Dekker HM, Kool DR, van Kuijk C, Edwards MJR, et al. Predictors for the selection of patients for abdominal CT after blunt trauma: a proposal for a diagnostic algorithm. Ann Surg. 2010;251(3):512-20. PMID: 20083993.
Eastern Association for the Surgery of Trauma (EAST). Blunt abdominal trauma, evaluation Available from: EAST Practice Management Guidelines archived page.
Engles S, Bhat R, Shivaraj G, Ponangi S. Emergency focused assessment with sonography in blunt abdominal trauma. Med J Armed Forces India. 2019;75(4):387-91. PMID: 31681541.
Ghafouri HB, Zare M, Bazrafshan A, Modirian E, Farahmand S, Abazarian N. Diagnostic accuracy of emergency-performed focused assessment with sonography for trauma (FAST) in blunt abdominal trauma. Electron Physician. 2016;8(9):2950-3. PMID: 27790349; PMCID: PMC5074755.
Heydari F, Esmailian M, Dehghanniri M. Diagnostic accuracy of focused assessment with sonography for trauma (FAST) in blunt abdominal trauma in pediatric patients performed by emergency medicine residents versus radiology residents.
Front Emerg Med. 2018;2(4):215-20. PMID: 31172094; PMCID: PMC6549207.
Hoff WS, Holevar M, Nagy KK, Patterson L, Young JS, Arrillaga A, et al.; EAST Practice Management Guidelines Work Group. Practice management guidelines for the evaluation of blunt abdominal trauma. J Trauma. 2002;53(3):602-15. doi:10.1097/00005373-200209000-00038. PMID: 12352507.
Kendall JL, Faragher J, Hewitt GJ, Burcham G, Haukoos JS. Emergency department ultrasound is not a sensitive detector of solid organ injury. West J Emerg Med. 2009;10(1):1-5. PMID: 19561757; PMCID: PMC2672300.
Kendall JL, Kestler AM, Whitaker KT, Adkisson MM, Haukoos JS. Blunt abdominal trauma patients are at very low risk for intra-abdominal injury after emergency department observation. West J Emerg Med. 2011;12(4):496-504. doi:10.5811/westjem.2010.11.2016. PMID: 22224146; PMCID: PMC3236146.
Kirkpatrick AW, Sirois M, Laupland KB, Goldstein L, Brown DR, Simons RK, et al. Prospective evaluation of hand-held focused abdominal sonography for trauma (FAST) in blunt abdominal trauma. Can J Surg. 2005;48(6):453-60. PMID: 16417051; PMCID: PMC3211725.
Mohammadi A, Ghasemi-Rad M. Evaluation of gastrointestinal injury in blunt abdominal trauma “FAST is not reliable”: the role of repeated ultrasonography. World J Emerg Surg. 2012;7(1):2. PMID: 22264345; PMCID: PMC3287959.
Natarajan B, Gupta PK, Cemaj S, Sorensen M, Hatzoudis GI, Forse RA. FAST scan: is it worth doing in hemodynamically stable blunt trauma patients? Surgery. 2010;148(4):695-700; discussion 700-1. PMID: 20800865.
Shyu JY, Khurana B, Soto JA, Biffl WL, Camacho MA, Diercks DB, et al.; Expert Panel on Major Trauma Imaging. ACR Appropriateness Criteria® Major Blunt Trauma. J Am Coll Radiol. 2020;17(5S):S160-S174. doi:10.1016/j.jacr.2020.01.024. PMID: 32370960.
Smyth L, Bendinelli C, Lee N, Reeds MG, Loh EJ, Amico F, et al. WSES guidelines on blunt and penetrating bowel injury: diagnosis, investigations, and treatment. World J Emerg Surg. 2022;17(1):13. doi:10.1186/s13017-022-00418-y. PMID: 35246190; PMCID: PMC8896237.
Stengel D, Bauwens K, Sehouli J, Rademacher G, Mutze S, Ekkernkamp A, et al. Point-of-care ultrasonography for diagnosing thoracoabdominal injuries in patients with blunt trauma. Cochrane Database Syst Rev. 2018;12(12):CD012669. PMID: 30548249.
Stengel D, Rademacher G, Ekkernkamp A, Güthoff C, Mutze S. Emergency ultrasound-based algorithms for diagnosing blunt abdominal trauma. Cochrane Database Syst Rev. 2015;(9):CD004446. PMID: 26368505; PMCID: PMC6464800.
Tsui CL, Fung HT, Chung KL, Kam CW. Focused abdominal sonography for trauma in the emergency department for blunt abdominal trauma. Int J Emerg Med. 2008;1(3):183-7. doi:10.1007/s12245-008-0050-2. PMID: 19384513; PMCID: PMC2657279.
Waheed KB, Baig AA, Raza A, Raza U. Diagnostic accuracy of focused assessment with sonography for trauma (FAST) for blunt abdominal trauma in the Eastern Region of Saudi Arabia. Cureus. 2018;10(6):e2998. PMID: 29915855; PMCID: PMC6058749.
