Evaluation of blunt abdominal trauma severity score in cases of blunt abdominal trauma

The utility of focused assessment with sonography for trauma (FAST) in children is poorly defined with considerable practice variation. Our purpose was to investigate the role of FAST for intra-abdominal injury (IAI) and IAI requiring acute intervention (IAI-I) in children after blunt abdominal trauma (BAT). We prospectively enrolled children younger than 16 years after BAT at 14 Level I pediatric trauma centers over a 1-year period. Patients who underwent FAST were compared with those that did not, using descriptive statistics and univariate analysis; p value less than 0.05 was considered significant. FAST test characteristics were performed using computed tomography (CT) and/or intraoperative findings as the gold standard. Two thousand one hundred eighty-eight children (age, 7.8 ± 4.6 years) were included. Eight hundred twenty-nine (37.9%) received a FAST, 340 of whom underwent an abdominal CT. Ninety-seven (29%) of these 340 patients had an IAI and 27 (7.9%) received an acute intervention. CT scan utilization after FAST was 41% versus 46% among those who did not receive FAST. The frequency of FAST among centers ranged from 0.84% to 94.1%. There was low correlation between FAST and CT utilization (r = -0.050, p < 0.001). Centers that performed FAST at a higher frequency did not have improved accuracy. The test performance of FAST for IAI was sensitivity, 27.8%; specificity, 91.4%; positive predictive value, 56.2%; negative predictive value, 76.0%; and accuracy, 73.2%. There were 81 injuries among the 70 false-negative FAST. The test performance of FAST for IAI-I was sensitivity, 44.4%; specificity, 88.5%; positive predictive value, 25.0%; negative predictive value, 94.9%; and accuracy, 85.0%. Fifteen children with a negative FAST received acute interventions. Among the 27 patients with true positive FAST examinations, 12 received intervention. All had an abnormal abdominal physical examination. No patient underwent intervention before CT scan. As currently used, FAST has a low sensitivity for IAI, misses IAI-I and rarely impacts management in pediatric BAT. Prognostic and epidemiologic study, level II; diagnostic tests or criteria study, level II; therapeutic/care management study, level III.

To validate the F-AST score as a CT decision tool in pediatric blunt abdominal trauma: A prospective diagnostic accuracy study.

Background: Focused Assessment with Sonography for Trauma (FAST) is a precise, non-invasive, and low cost method to assess free abdominal fluid in trauma patients. Objective: This study assessed the relationship between free intra-abdominal fluid and organ injury in blunt abdominal trauma and designed a scoring system based on FAST. Patients and Methods: A total of 200 patients with blunt abdominal trauma who had stable vital signs were assessed. For all patients, FAST sonography was done by one sonographer and the free fluid score in the abdomen, which was in the range of 0-8, was calculated. Immediately, an intravenous contrast-enhanced CT was performed in all patients and abdominal solid organ injuries were assessed. Results were analyzed using the Kruskal-Wallis test, the Mann-Whitney test, and ROC curves. Results: The mean age of the patients was 29.6 ± 18.3. In 71% of patients, trauma injury was due to car accidents. FAST was negative in 33% of subjects. Considering the cut-off point of 3, sensitivity, specificity, positive predictive value, and negative predictive value were calculated to be 0.83, 0.98, 0.93, and 0.95, respectively. Comparing the mean scores from FAST and CT-scan results showed that there is a correlation between the severities of organ injury and FAST scores (p < 0.001). Conclusion: It was found that the amount of the intra-abdominal free fluid measured by FAST is associated with solid abdominal organ injury in patients with blunt trauma.

In children with blunt abdominal trauma (BAT), focused assessment of sonography in trauma (FAST) has been reported with low sensitivity, on the whole, in the detection of intra-abdominal injuries (IAI). The aim of the present study was to assess test characteristics of FAST using different strategies including repeated FAST (reFAST), and physical exam findings. This retrospective study evaluated BAT pediatric patients with stable hemodynamics who underwent computed tomography (CT). Demographic data, initial physical examination, and results of FAST, reFAST (if done), and CT imaging were recorded. Different strategies of FAST were cross-tabulated with CT as the gold standard and test characteristics including sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy were interpreted. 129 patients with a mean age of 8.6 ± 4.7 were studied and 74% were male. Comparing CT-positive and -negative groups, from the demographic and clinical findings, only positive physical exam (tenderness or ecchymosis) was significantly higher in the CT-positive group (59% vs. 17%; p < 0.01). In a multivariate analysis, positive FAST modality and clinical exam remained independent predictors for a positive CT result (likelihood ratios of 34.6 and 6.4, respectively). Out of the different diagnostic strategies for the prediction of IAI, the best overall performance resulted from the FAST-reFAST-tenderness protocol with sensitivity, specificity, PPV, NPV, and accuracy of 87%, 77%, 70%, 91%, and 81%. For children with blunt abdominal trauma, physical examination plus FAST and reFAST as needed, seems to have reasonable sensitivity, specificity, and accuracy in detecting intra-abdominal injuries and may reduce the need for CT scans.

Introduction:Focused assessment with sonography for trauma (FAST) has been shown to be useful to detect intraperitoneal free fluid in patients with blunt abdominal trauma (BAT). Objective:We compared the diagnostic accuracy of FAST performed by emergency medicine residents (EMRs) and radiology residents (RRs) in pediatric patients with BAT.Method:In this prospective study, pediatric patients with BAT and high energy trauma who were referred to the emergency department (ED) at Al-Zahra and Kashani hospitals in Isfahan, Iran, were evaluated using FAST, first by EMRs and subsequently by RRs. The reports provided by the two resident groups were compared with the final outcome based on the results of the abdominal computed tomography (CT), operative exploration, and clinical observation. Results:A total of 101 patients with a median age of 6.75 ± 3.2 years were enrolled in the study between January 2013 and May 2014. These patients were evaluated using FAST, first by EMRs and subsequently by RRs. A good diagnostic agreement was noted between the results of the FAST scans performed by EMRs and RRs (κ = 0.865, P < 0.001). The sensitivity, specificity, positive and negative predictive values, and accuracy in evaluating the intraperitoneal free fluid were 72.2%, 85.5%, 52%, 93.3%, and 83.2%, respectively, when FAST was performed by EMRs and 72.2%, 86.7%, 54.2%, 93.5%, and 84.2%, respectively, when FAST was performed by RRs. No significant differences were seen between the EMR- and RR-performed FAST. Conclusion:In this study, FAST performed by EMRs had acceptable diagnostic value, similar to that performed by RRs, in patients with BAT.

Background:In previous studies, the diagnostic value of Focused Assessment with Sonography for Trauma (FAST) has been evaluated but few studies have been performed on the relationship between the amount of free intra-abdominal fluid and organ injury in blunt abdominal trauma. To select patients with a higher probability of intra-abdominal injuries, several scoring systems have been proposed based on the results of FAST.Objectives:The aim of this study was to determine the prognostic value of FAST according to the Huang scoring system and to propose a cut-off point for predicting the presence of intra-abdominal injuries on the Computed Tomography (CT) scan. The correlation between age and Glasgow Coma Scale (GCS) and the presence of intra-abdominal injuries on the CT scan was also assessed.Patients and Methods:This study was performed on 200 patients with severe blunt abdominal trauma who had stable vital signs. For all patients, FAST-ultrasound was performed by a radiologist and the free fluid score in the abdomen was calculated according to the Huang score. Immediately, an intravenous contrast-enhanced abdominal CT scan was performed in all patients and abdominal solid organ injuries were assessed. Results were analyzed using Kruskal-Wallis test, Mann-Whitney test and ROC curves. The correlation between age and GCS and the presence of intra-abdominal injuries on CT-scan was also evaluated.Results:The mean age of the patients was 29.6 ± 18.3 years and FAST was positive in 67% of the subjects. A significant correlation was seen between the FAST score and the presence of organ injury on CT scan (P < 0.001). Considering the cut-off point of 3 for the free fluid score (with a range of 0-8), sensitivity, specificity, positive predictive value and negative predictive value were calculated to be 0.83, 0.98, 0.93, and 0.95, respectively. Age and GCS showed no significant correlation with intra-abdominal injuries.Conclusions:It seems that FAST examination for intra-abdominal fluid in blunt trauma patients can predict intra-abdominal injuries with very high sensitivity and specificity. Using the scoring system can more accurately determine the probability of the presence of abdominal injuries with a cut-off point of three.

Pediatric FAST and Elevated Liver Transaminases: An Effective Screening Tool in Blunt Abdominal Trauma

HomeRadioGraphicsVol. 28, No. 1 PreviousNext RSNA Education ExhibitsInvited CommentaryStuart E. MirvisStuart E. MirvisAuthor AffiliationsDepartment of Diagnostic Imaging and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, MarylandStuart E. MirvisPublished Online:Jan 1 2008https://doi.org/10.1148/radiographics.28.1.0280241MoreSectionsFull textPDF ToolsImage ViewerAdd to favoritesCiteTrack CitationsPermissionsReprints ShareShare onFacebookTwitterLinked In References1 KörnerM, Krotz MM, Degenhart C, Pfeifer KJ, Reiser MF, Linsenmaier U. Current role of emergency US in patients with major trauma. RadioGraphics2008; 28(1): 225–244. Link, Google Scholar2 TsoP, Rodriguez A, Cooper C, et al. Sonography in blunt abdominal trauma, a preliminary progress report. J Trauma1992; 33(1): 39–43. Crossref, Medline, Google Scholar3 BodePJ, Edwards MJ, Kruit MC, van Vugt AB. Sonography in a clinical algorithm for early evaluation of 1671 patients with blunt abdominal trauma. AJR Am J Roentgenol1999; 172(4): 905–911. Crossref, Medline, Google Scholar4 ScaleaTM, Rodriguez A, Chiu WC, et al. Focused Assessment with Sonography for Trauma (FAST): results from an international consensus conference. J Trauma1999; 46(3): 466–472. Crossref, Medline, Google Scholar5 JangT, Sineff S, Naunheim R, Aubin C. Residents should not independently perform focused abdominal sonography for trauma after 10 training examinations. J Ultrasound Med2004; 23: 793–797. Crossref, Medline, Google Scholar6 PolettiPA, Kinkel K, Vermeulen B, Irmay F, Unger PF, Terrier F. Blunt abdominal trauma: should US be used to detect both free fluid and organ injuries? Radiology2003; 227: 95–103. Link, Google Scholar7 ShanmuganathanK, Mirvis SE, Sherbourne CD, Chiu WC, Rodriguez A. Hemoperitoneum as the sole indicator of abdominal visceral injuries: a potential limitation of screening abdominal US for trauma. Radiology1999; 212(2): 423–430. Link, Google Scholar8 McGahanJP, Richards JR, Jones CD, Gerscovich EO. Use of ultrasonography in the patient with acute renal trauma. J Ultrasound Med1999; 18(3): 207–213. Crossref, Medline, Google Scholar9 UdobiKF, Rodriguez A, Chiu WC, Scalea TM. Role of ultrasonography in penetrating abdominal trauma: a prospective clinical study. J Trauma2001; 50(3): 475–479. Crossref, Medline, Google Scholar10 McGahanJP, Horton S, Gerscovich EO, et al. Appearance of solid organ injury with contrast-enhanced sonography in blunt abdominal trauma: preliminary experience. AJR Am J Roentgenol2006; 187(3): 658–666. Crossref, Medline, Google Scholar11 ShanmuganathanK, Mirvis SE, Boyd-Kranis R, Takada T, Scalea TM. Nonsurgical management of blunt splenic injury: use of CT criteria to select patients for splenic arteriography and potential endovascular therapy. Radiology2000; 217(1): 75–82. Link, Google Scholar12 PolettiPA, Mirvis SE, Shanmuganathan K, et al. Blunt abdominal trauma patients: can organ injury be excluded without performing computed tomography? J Trauma2004; 57(5): 1072–1081. Crossref, Medline, Google Scholar13 LambAD, Qadan M, Gray AJ. Detection of occult pneumothoraces in the significantly injured adult with blunt trauma. Eur J Emerg Med2007; 14(2): 65–67. Crossref, Medline, Google ScholarArticle HistoryPublished in print: Jan 2008 FiguresReferencesRelatedDetailsCited ByUltrasound, Vol. 18, No. 1Recommended Articles Focused Assessment with Sonography in Trauma (FAST) in 2017: What Radiologists Can LearnRadiology2017Volume: 283Issue: 1pp. 30-48A Multiscale Deep Learning Method for Quantitative Visualization of Traumatic Hemoperitoneum at CT: Assessment of Feasibility and Comparison with Subjective Categorical EstimationRadiology: Artificial Intelligence2020Volume: 2Issue: 6Imaging Manifestations of Chest TraumaRadioGraphics2021Volume: 41Issue: 5pp. 1321-1334Effect of an Institutional Triaging Algorithm on the Use of Multidetector CT for Patients with Blunt Abdominopelvic Trauma over an 8-year PeriodRadiology2016Volume: 282Issue: 1pp. 84-91Multidetector CT of Surgically Proven Blunt Bowel and Mesenteric InjuryRadioGraphics2017Volume: 37Issue: 2pp. 613-625See More RSNA Education Exhibits Chest Trauma: The Role of the Radiologist From Diagnosis to InterventionDigital Posters2020To the OR or to IR? That is the Question: Review of Important Pancreatic, Liver, and Splenic CT Findings For the Surgeon and InterventionalistDigital Posters2020Pictorial Review of Cardiac Tamponade: What Radiologists Need to KnowDigital Posters2019 RSNA Case Collection Splenic Injury following ColonoscopyRSNA Case Collection2021Traumatic Diaphragmatic RuptureRSNA Case Collection2021Cardiac tamponadeRSNA Case Collection2022 Vol. 28, No. 1 Metrics Altmetric Score PDF download

Purpose This study aimed to evaluate the accuracy and outcomes of focused assessment with sonography for trauma (FAST) and determine the factors associated with true-positive FAST results. Methods The FAST results from 2016 to 2020 were retrospectively reviewed. Cases involving penetrating injury, transfer from other hospitals, age ≤ 16 years, prehospital arrest, and no confirmatory test were excluded. Intra-abdominal fluid was confirmed using computed tomography or operative findings. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated. Demographic data, injury characteristics, and outcomes were compared between true-positive and false-negative results. Logistic regression was used to identify the factors associated with true-positive results. Results Of 2,758 patients, 163 and 2,595 patients showed positive and negative results, respectively. True positives were 135 and true negatives were 2325. The overall sensitivity, specificity, PPV, and NPV were 33.3%, 98.8%, 82.8%, and 89.6%, respectively. The sensitivity increased to 49.1% in patients with initial systolic blood pressure (SBP) ≤ 90 mmHg. The true-positive group showed a lower SBP and Glasgow Coma Scale score and a higher laparotomy rate than the false-negative group. However, mortality showed no significant difference. In logistic regression analysis, hollow viscus injury (1.820 [1.123–2.949], P=0.015) and the lowest SBP (0.988 [0.980–0.997], P=0.009) were associated with true-positive results compared to false-negative results. Conclusion The overall sensitivity of FAST was low; therefore, it should be performed in selected patients such as SBP ≤ 90 mmHg. Because of its low sensitivity and no influence on outcome, physicians should not rely solely on FAST.

Objective The aim of this study was to evaluate the results of focused assessment with sonography for trauma (FAST) in hemodynamically unstable blunt traumatized patients and to determine its role in the diagnostic evaluation of these patients. Background The emergency physician faces significant clinical uncertainty when a multiple trauma patient arrives in the emergency department. Patients are assessed, and their treatment priorities are established in the primary survey. FAST is an important skill during trauma resuscitation. The use of point-of-care ultrasound among the trauma team working in the primary survey in emergency care settings is lacking in Menoufia university hospitals. Patients and methods This study was conducted on 50 patients with blunt abdominal trauma, either a localized trauma to the abdomen or a polytrauma with a blunt mechanism. The patients were assessed in the primary survey using the FAST as a tool to determine the presence of intra-abdominal collection. Results There were a total of 50 cases, and FAST scans were performed in all cases. The sensitivity and specificity were 92.6 and 100%, respectively. The negative predictive value was 92%, whereas the positive predictive value was 100%. The overall accuracy was 96%. Conclusion FAST with presence of free fluid intraperitoneal without reference to the amont is useful as the initial diagnostic tool for abdominal trauma to detect intra-abdominal fluid in hemodynamically unstable patients. FAST performed by clinicians detects intraperitoneal fluid with a high degree of accuracy. All FAST examinations are valuable tests when positive. However, ultrasound examination is operator dependent, and FAST scan has its own limitations. For negative FAST scan cases, we recommend a period of monitoring, serial FAST scans, or further investigations, such as computed tomography scan.

The utility of focused abdominal ultrasound in blunt abdominal trauma: a reappraisal

Focused assessment with sonography for trauma (FAST) has been incorporated into the initial evaluation of trauma for decades. It is an important screening tool in the detection of intra-abdominal fluid. The objective of this study was to perform a systematic review of the use and accuracy of FAST as an imaging tool for blunt abdominal trauma in disaster/mass casualty settings. A systematic review of literature was conducted using key words and search terms. Two independent reviewers screened abstracts to determine inclusion using the Quality Assessment of Diagnostic Accuracy Studies (QUADAS). For studies passing QUADAS, a meta-analysis was performed calculating sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV). FAST results were compared with the gold standard, which was a combination of CT scan results, operative findings, and medical records of the clinical course. Initial database screening resulted in 133 articles, of which 21 were selected for QUADAS evaluation. Five studies passed QUADAS and were selected in the final meta-analysis, with a total of 4263 patients. The sensitivity of FAST was 92.1% (87.8-95.6), specificity 98.7% (96.0-99.9), PPV 90.7% (70.0-98.0), and NPV 98.8% (98.1-99.5) for the detection of intra-abdominal injury. In our meta-analysis, FAST was both sensitive and specific in the evaluation of trauma in the disaster setting.

Objective: To compare the diagnostic accuracy of focused assessment with sonography for trauma (FAST) performed by emergency medicine (EM) residents versus radiology residents in detecting intra-peritoneal free fluid, using contrast-enhanced computed tomography (CT) of the abdomen as the reference standard. Methods: This cross-sectional diagnostic validation study was conducted over six months (July–December 2024) in the Emergency Department of POF Wah Cantt. A total of 285 adult patients (aged 16–65 years) with blunt abdominal trauma, who were hemodynamically stable, were enrolled through non-probability consecutive sampling. All patients underwent FAST scans performed independently by EM and radiology residents, blinded to each other's findings. The reference test was CT abdomen, reported by a consultant radiologist. Diagnostic accuracy parameters (sensitivity, specificity, positive predictive value [PPV], negative predictive value [NPV], and overall accuracy) were calculated for each group, with subgroup analyses by gender, age, and mechanism of injury. Results: Intra-peritoneal free fluid was confirmed on CT in 43 patients (15.1%). EM residents demonstrated 72.1% sensitivity, 97.1% specificity, 81.6% PPV, 95.1% NPV, and 93.3% accuracy. Radiology residents yielded 74.4% sensitivity, 98.3% specificity, 88.9% PPV, 95.6% NPV, and 95.1% accuracy. Subgroup analyses by gender, age, and injury mechanism revealed consistent performance across all strata. No statistically significant differences were observed between the two groups for any metric (p &gt; 0.05). Conclusion: FAST scans performed by trained EM residents demonstrated diagnostic accuracy comparable to radiology residents, supporting their reliable use in the initial evaluation of blunt abdominal trauma.

Background: Focused assessment with sonography for trauma (FAST) has a role in the rapid screening of hemodynamically unstable patients to decide on management, however, its role in hemodynamically stable patients remains equivocal. Objectives: This study aimed to determine the sensitivity and specificity rate of FAST for intra-abdominal injury (IAI) in hemodynamically stable blunt abdominal trauma patients. Secondary outcomes like Glasgow coma score, length of hospital stays (LOS), head injury, and mortality were also examined for their association with FAST scan results. Settings and Design: A retrospective cross-sectional study was conducted in level-one trauma center in Bahrain. Methods: This study was conducted from January 2019 to October 2020. A total of 191 trauma codes were activated during this period, however, only 112 patients were included based on the inclusion criteria. Results: FAST scan in hemodynamically stable patients was found to have a higher specificity (96.7%) than sensitivity (30%) in this study. A higher negative predictive value (NPV) (86.4%) compared to a positive predictive value (66.6%) and a high accuracy rate (84.8%) was observed. LOS showed significant association only with FAST diagnostic accuracy. Conclusion: In hemodynamically stable patients; FAST is better at ruling in intra IAI when compared to ruling out and its high NPV supports it being a good screening tool. The results do not support the use of FAST as the sole diagnostic tool without performing computed tomography scan.

Blunt Abdominal Trauma (BAT) remains a diagnostic challenge, even for experienced trauma surgeons. Objective: To evaluate the diagnostic accuracy of Focused Assessment with Sonography for Trauma (FAST) in detecting intra-abdominal injuries among patients presenting with blunt abdominal trauma in a tertiary care emergency setting. Methods: This cross-sectional analytical study was conducted at the Emergency Department of Lady Reading Hospital, Peshawar, from May 2024 to February 2025. A total of 106 patients were enrolled, calculated using OpenEpi based on an expected FAST sensitivity of 78%, 20% IAI prevalence, 80% confidence level, and 5% margin of error. Patients with penetrating abdominal trauma or contraindications to FAST were excluded. Positive FAST was defined by free fluid in standard regions (perihepatic, perisplenic, pelvic, or pericardial). CT scan, interpreted by a radiologist, served as the reference standard for IAI—defined as evidence of organ laceration, hematoma, or active bleeding. FAST scans were performed by trained emergency physicians during initial assessment, with CT scans conducted within one hour in stable patients. Operator qualifications included certification in trauma ultrasonography. Results: Of the 106 patients, FAST demonstrated a sensitivity of 78.9%, specificity of 91.8%, and overall diagnostic accuracy of 84.9% in detecting IAI. There were no significant demographic or clinical differences between FAST-positive and FAST-negative groups. Data were analyzed using SPSS v23.0, with p &lt; 0.05 considered significant. Conclusion: FAST is a valuable, rapid bedside screening tool for initial evaluation of BAT, offering high specificity and acceptable sensitivity.