Predictive value of a false-negative focused abdominal sonography for trauma (FAST) result in patients with confirmed traumatic abdominal injury

Mohammed H A Alramdan,Frank F A Ijpma,Derya Yakar,Thomas C Kwee,Ömer Kasalak

doi:10.1186/s13244-020-00911-5

Mohammed H A Alramdan, Frank F A Ijpma + Show 3 more

Open Access

https://doi.org/10.1186/s13244-020-00911-5

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Abstract

ObjectiveTo investigate if patients with confirmed traumatic abdominal injury and a false-negative focused abdominal sonography for trauma (FAST) examination have a more favorable prognosis than those with a true-positive FAST.MethodsThis study included 97 consecutive patients with confirmed traumatic abdominal injury (based on computed tomography [CT] and/or surgical findings) who underwent FAST.ResultsFAST was false-negative in 40 patients (41.2%) and true-positive in 57 patients (58.8%). Twenty-two patients (22.7%) had an unfavorable outcome (defined as the need for an interventional radiologic procedure, laparotomy, or death due to abdominal injury). Univariately, a false-negative FAST (odds ratio [OR] 0.24; p = 0.017) and a higher systolic blood pressure (OR, 0.97 per mmHg increase; p = 0.034) were significantly associated with a favorable outcome, whereas contrast extravasation on CT (OR, 7.17; p = 0.001) and shock index classification (OR, 1.89 for each higher class; p = 0.046) were significantly associated with an unfavorable outcome. Multivariately, only contrast extravasation on CT remained significantly associated with an unfavorable outcome (OR, 4.64; p = 0.016). When excluding contrast extravasation on CT from multivariate analysis, only a false-negative FAST result was predictive of a favorable outcome (OR, 0.28; p = 0.038).ConclusionTrauma patients with confirmed abdominal injury and a false-negative FAST have a better outcome than those with a positive FAST. FAST may be valuable for risk stratification and prognostication in patients with a high suspicion of abdominal injury when CT has not been performed yet or when CT is not available.

Highlights

Injury is an important cause of morbidity and mortality in the developed and developing world [1]
Focused abdominal sonography for trauma (FAST) may be valuable for risk stratification and prognostication in patients with a high suspicion of abdominal injury when computed tomography (CT) has not been performed yet or when CT is not available
Only contrast extravasation on CT remained significantly associated with an unfavorable outcome (OR, 4.64; p = 0.016), whereas FAST result and systolic blood pressure had no significant independent association with outcome (Table 4)

Summary

Introduction

Injury is an important cause of morbidity and mortality in the developed and developing world [1]. Imaging plays an important role in patients with suspected abdominal injury [4]. Focused abdominal sonography for trauma (FAST) is an abbreviated, protocolized form of ultrasonography to rapidly screen for the presence of free intra-abdominal fluid as an indirect sign of abdominal injury [1]. A meta-analysis that investigated the value of FAST for the detection of free intra-abdominal fluid in a total of 19,666 trauma patients reported a pooled sensitivity of 74.2% and a pooled specificity of 97.6% [4]. These data underline that FAST in trauma is helpful to rule in, but not to rule out, free intra-abdominal fluid [4]

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