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The Utility of Sonography for the Triage of Blunt Abdominal Trauma Patients to Exploratory Laparotomy

¹ Department of Radiology, University of California Davis School of Medicine and University of California Davis Medical Center, 4860 Y St., Ste. 3100, Sacramento, CA 95817.
² Department of Emergency Medicine, University of California Davis School of Medicine and University of California Davis Medical Center, Sacramento, CA.

OBJECTIVE. The purpose of this study was to assess the utility of focused abdominal sonography for trauma (FAST) in the triage of hypotensive and normotensive blunt abdominal trauma patients to exploratory laparotomy.

MATERIALS AND METHODS. Data entered in a trauma registry database were retrospectively reviewed and were correlated with medical records, radiology reports, and surgical laparotomy reports. In the setting of blunt abdominal trauma, hypotensive patients were compared with normotensive patients who underwent FAST.

RESULTS. During the 6-year study period, 4,029 patients with blunt abdominal trauma underwent sonography, 122 of whom were hypotensive on arrival and underwent FAST. Of 87 hypotensive patients with positive findings on FAST, 69 (79%) were taken directly to exploratory laparotomy without the need for CT. In predicting the need for therapeutic laparotomy in hypotensive patients, the sensitivity of FAST was 85%, specificity was 60%, and accuracy was 77%. Of the 3,907 normotensive patients, 3,584 had negative FAST findings, whereas 323 had positive FAST findings. In normotensive patients, the sensitivity of FAST was 85%, specificity was 96%, and accuracy was 96%. In the combined patient population (all hypotensive and normotensive patients), 4,029 patients with blunt abdominal trauma underwent sonography: 3,619 had negative and 410 had positive FAST findings. In all patients regardless of blood pressure, the sensitivity of FAST was 85%, specificity was 96%, and accuracy was 95%.

CONCLUSION. Hypotensive patients screened in the emergency department with positive FAST findings may be triaged directly to therapeutic laparotomy, depending on the results of the sonography examination, without the need for CT.

Keywords: abdominal imaging • blunt trauma • emergency radiology • exploratory laparotomy • FAST • focused abdominal sonography for trauma • sonography

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