Patients with penetrating abdominal...

Patients with penetrating abdominal injuries require rapid, cost-effective assessment that can find out all significant injuries without exposing the patient to unnecessary delays or complications. Physical examination can be inaccurate, while other diagnostic modalities have advantages and drawbacks. Focused assessment with sonography for trauma (FAST) is a rapid, portable, ultrasonographic screening tool perform the operations indicated ined mainly to detect free peritoneal or pericardial fluid. Kirkpatrick and colleagues evaluated the part of FAST in the assessment of patients admitted to couple major trauma centers, one U and common Canadian.

At the pair participating centers, all critically injured patients were assessed from a team led by a trauma surgeon or a trauma companion This person performed handheld FAST examinations onward 38 patients before other evaluation was undertaken. The FAST examinations were interpreted before other investigations were done. The completed patient assessment typically was carried gone out by another team member. The handheld FAST assessments were compared with the final assessment based in succession several modalities, including floor-based ultrasonographic screening, comput tomographic screening, and operative or autopsy findings.

Compared with conventional ultrasonographic screening examination, the handheld FAST accurately diagnosed independent intraperitoneal fluid in 11 of the 12 patients with emancipated intraperitoneal fluid. Sensitivity was 92 per-cent and specificity was 100 percent In the merely false-negative case, the examining surgeon was interrupted on an urgent case, which could have contributed to the negative interpretation. The diagnosis of liberated fluid was made within secondarys using handheld ultrasonographic screening and the diagnostic impression was likewise strong that, in positive cases, the examiner acted to intervention without conducting assessment of all sites. Handheld FAST also was moderately felicitous in detecting intraperitoneal injuries.

The authors decide that the handheld FAST provides an extremely rapid and reliable touchstone for free intraperitoneal fluid in strictly injured patients. Because the vicinity of free intraperitoneal fluid after penetrating trauma almost always indicates significant injury, the use of handheld FAST could avoid delay and the ne for extensive investigation in these patients. The authors praise that negative examinations be followed by dint of more extensive diagnostic evaluation because of the limited ability of handheld FAST to reliably discover intra-abdominal injuries.

Kirkpatrick AW, et al. The hand-held ultrasound examination for penetrating abdominal trauma. Am J Surg May 2004;187:660-5

COPYRIGHT 2005 American Academy of Family Physicians

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