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Focused abdominal ultrasound for blunt trauma in an emergency department without advanced imaging or on-site surgical capability

Published online by Cambridge University Press:  21 May 2015

Michael Shuster ,
Riyad B. Abu-Laban ,
Jeff Boyd ,
Charles Gauthier ,
Sandra Mergler ,
Lance Shepherd  and
Chris Turner
Michael Shuster*
Affiliation:
Department of Emergency Medicine, Mineral Springs Hospital, Banff, Alta
Riyad B. Abu-Laban
Affiliation:
Department of Emergency Medicine and the Centre for Clinical Epidemiology and Evaluation, Vancouver General Hospital, Division of Emergency Medicine, University of British Columbia, Vancouver, BC
Jeff Boyd
Affiliation:
Department of Emergency Medicine, Mineral Springs Hospital, Banff, Alta
Charles Gauthier
Affiliation:
Department of Emergency Medicine, Mineral Springs Hospital, Banff, Alta
Sandra Mergler
Affiliation:
Department of Emergency Medicine, Mineral Springs Hospital, Banff, Alta
Lance Shepherd
Affiliation:
Department of Emergency Medicine, Mineral Springs Hospital, Banff, Alta
Chris Turner
Affiliation:
Department of Emergency Medicine, Mineral Springs Hospital, Banff, Alta
*
Mineral Springs Hospital, Box 1050, Banff AB T1L 1H7; shuster@telus.net

Abstract:

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Objectives:

To determine whether focused abdominal sonogram for trauma (FAST) in a rural hospital provides information that prompts immediate transfer to a tertiary care facility for patients with blunt abdominal trauma who would otherwise be discharged or held for observation.

Methods:

Prior to the study, participating emergency physicians underwent a minimum of 30 hours of ultrasound training. All patients who presented with blunt abdominal trauma to our rural hospital between Mar. 1, 2002, and Apr. 30, 2003, were eligible for study. Following a history and physical examination, the emergency physician documented his or her disposition decision. A FAST was then performed, and the disposition reconsidered in light of the FAST results.

Results:

Sixty-seven FAST exams were performed on 65 patients. Three examinations (4.5%) were true-positive (95% confidence interval [CI] 0.9%–12.5%); 60 (89.6%) were true-negative (95% CI 79.7%–95.7%), 4 (6%) were false-negative (95% CI 1.7%–14.6%) and none (0%) were false-positive (95% CI 0%–5.4%). These values reflect sensitivity, specificity, negative predictive value and positive predictive values of 43%, 100%, 94% and 100% respectively. FAST results did not alter the decision to transfer any patient (0%: 95% CI 0.0%–5.4%), although one positive FAST may have led to an expedited transfer. One of 38 patients who was discharged after a negative FAST study returned 24 hours later because of worsening symptoms, and was ultimately found to have splenic and pancreatic injuries.

Conclusions:

This study failed to demonstrate that FAST improves disposition decisions for patients with blunt abdominal trauma who are evaluated in a hospital without advanced imaging or on-site surgical capability. However, the study is not sufficiently powered to rule out a role for FAST in these circumstances, and our data suggest that up to 5.4% of transfer decisions could be influenced by FAST. Rural emergency physicians should not allow a negative FAST study to override a clinical indication for transfer to a trauma centre; however, positive FAST studies can be used to accelerate transfer for definitive treatment.

Keywords

ultrasonographyemergency medicineblunt traumaabdominal injuriesrural hospitals
Type
Em Advances • Innovations en MU
Information
Canadian Journal of Emergency Medicine , Volume 6 , Issue 6 , November 2004 , pp. 408 - 415
Copyright
Copyright © Canadian Association of Emergency Physicians 2004

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