The focused assessment with sonography in trauma (FAST) in hypotensive injured patients frequently fails to identify the need for laparotomy: A multiinstitutional pragmatic study

PROMMTT Study Group

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

Background The ability of focused assessment with sonography for trauma (FAST) to detect clinically significant hemorrhage in hypotensive injured patients remains unclear. We sought to describe the sensitivity and specificity of FAST using findings at laparotomy as the confirmatory test. Methods Patients from the Prospective Observational Multicenter Major Trauma Transfusion (PROMMTT) study that had a systolic blood pressure < 90mm Hg and underwent FAST were analysed. Results were compared with findings at laparotomy. A therapeutic laparotomy (T-LAP) was defined as an abdominal operation within 6 hours in which a definitive procedure was performed. The sensitivity and specificity of FAST were calculated. Results The cohort included 317 patients that underwent FAST (108 positive, 209 negative). T-LAP was performed in 69% (n=75) of FAST(+) patients and 22% (n=48) of FAST(-) patients. FAST had a sensitivity of 62% and specificity of 83%. Conclusions In our multicenter cohort, 22% of FAST(-) patients underwent T-LAP within 6 hours of admission. In hypotensive patients with a negative FAST, clinicians should still maintain a high index of suspicion for significant abdominal hemorrhage. Level of evidence Level IV.

Original languageEnglish (US)
Article numbere000207
JournalTrauma Surgery and Acute Care Open
Volume4
Issue number1
DOIs
StatePublished - Jan 1 2019

Fingerprint

Laparotomy
Ultrasonography
Wounds and Injuries
Sensitivity and Specificity
Hemorrhage
Blood Pressure
Therapeutics

ASJC Scopus subject areas

  • Surgery
  • Critical Care and Intensive Care Medicine

Cite this

@article{b10eb855aa9b49bbac09fcc180ad4e0d,
title = "The focused assessment with sonography in trauma (FAST) in hypotensive injured patients frequently fails to identify the need for laparotomy: A multiinstitutional pragmatic study",
abstract = "Background The ability of focused assessment with sonography for trauma (FAST) to detect clinically significant hemorrhage in hypotensive injured patients remains unclear. We sought to describe the sensitivity and specificity of FAST using findings at laparotomy as the confirmatory test. Methods Patients from the Prospective Observational Multicenter Major Trauma Transfusion (PROMMTT) study that had a systolic blood pressure < 90mm Hg and underwent FAST were analysed. Results were compared with findings at laparotomy. A therapeutic laparotomy (T-LAP) was defined as an abdominal operation within 6 hours in which a definitive procedure was performed. The sensitivity and specificity of FAST were calculated. Results The cohort included 317 patients that underwent FAST (108 positive, 209 negative). T-LAP was performed in 69{\%} (n=75) of FAST(+) patients and 22{\%} (n=48) of FAST(-) patients. FAST had a sensitivity of 62{\%} and specificity of 83{\%}. Conclusions In our multicenter cohort, 22{\%} of FAST(-) patients underwent T-LAP within 6 hours of admission. In hypotensive patients with a negative FAST, clinicians should still maintain a high index of suspicion for significant abdominal hemorrhage. Level of evidence Level IV.",
author = "{PROMMTT Study Group} and Rowell, {Susan E.} and Barbosa, {Ronald R.} and Holcomb, {John B.} and Fox, {Erin E.} and Barton, {Cassie A.} and Schreiber, {Martin A.} and Rahbar, {Mohammad H.} and {Del Junco}, {Deborah J.} and Wade, {Charles E.} and Jiajie Zhang and Nena Matijevic and Yu Bai and Weiwei Wang and Jeanette Podbielski and Duran, {Sarah J.} and Ruby Benjamin-Garner and Reynolds, {Robert J.} and White, {Christopher E.} and Franzen, {Kimberly L.} and Coates, {Elsa C.} and Brasel, {Karen J.} and Pamela Walsh and Underwood, {Samantha J.} and Jodie Curren and Cohen, {Mitchell J.} and {Margaret Knudson}, M. and Mary Nelson and Call, {Mariah S.} and Peter Muskat and Johannigman, {Jay A.} and Robinson, {Bryce R.H.} and Richard Branson and Dina Gomaa and Cendi Dahl and Alarcon, {Louis H.} and Peitzman, {Andrew B.} and Stull, {Stacy D.} and Mitch Kampmeyer and Early, {Barbara J.} and Shnol, {Helen L.} and Zolin, {Samuel J.} and Sears, {Sarah B.} and Holcomb, {John B.} and Cotton, {Bryan A.} and Marily Elopre and Hatch, {Quinton M.} and Michelle Scerbo and Zerremi Caga-Anan and Herbert Phelan and Minei, {Joseph P}",
year = "2019",
month = "1",
day = "1",
doi = "10.1136/tsaco-2018-000207",
language = "English (US)",
volume = "4",
journal = "Trauma Surgery and Acute Care Open",
issn = "2397-5776",
publisher = "BMJ Publishing Group",
number = "1",

}

TY - JOUR

T1 - The focused assessment with sonography in trauma (FAST) in hypotensive injured patients frequently fails to identify the need for laparotomy

T2 - A multiinstitutional pragmatic study

AU - PROMMTT Study Group

AU - Rowell, Susan E.

AU - Barbosa, Ronald R.

AU - Holcomb, John B.

AU - Fox, Erin E.

AU - Barton, Cassie A.

AU - Schreiber, Martin A.

AU - Rahbar, Mohammad H.

AU - Del Junco, Deborah J.

AU - Wade, Charles E.

AU - Zhang, Jiajie

AU - Matijevic, Nena

AU - Bai, Yu

AU - Wang, Weiwei

AU - Podbielski, Jeanette

AU - Duran, Sarah J.

AU - Benjamin-Garner, Ruby

AU - Reynolds, Robert J.

AU - White, Christopher E.

AU - Franzen, Kimberly L.

AU - Coates, Elsa C.

AU - Brasel, Karen J.

AU - Walsh, Pamela

AU - Underwood, Samantha J.

AU - Curren, Jodie

AU - Cohen, Mitchell J.

AU - Margaret Knudson, M.

AU - Nelson, Mary

AU - Call, Mariah S.

AU - Muskat, Peter

AU - Johannigman, Jay A.

AU - Robinson, Bryce R.H.

AU - Branson, Richard

AU - Gomaa, Dina

AU - Dahl, Cendi

AU - Alarcon, Louis H.

AU - Peitzman, Andrew B.

AU - Stull, Stacy D.

AU - Kampmeyer, Mitch

AU - Early, Barbara J.

AU - Shnol, Helen L.

AU - Zolin, Samuel J.

AU - Sears, Sarah B.

AU - Holcomb, John B.

AU - Cotton, Bryan A.

AU - Elopre, Marily

AU - Hatch, Quinton M.

AU - Scerbo, Michelle

AU - Caga-Anan, Zerremi

AU - Phelan, Herbert

AU - Minei, Joseph P

PY - 2019/1/1

Y1 - 2019/1/1

N2 - Background The ability of focused assessment with sonography for trauma (FAST) to detect clinically significant hemorrhage in hypotensive injured patients remains unclear. We sought to describe the sensitivity and specificity of FAST using findings at laparotomy as the confirmatory test. Methods Patients from the Prospective Observational Multicenter Major Trauma Transfusion (PROMMTT) study that had a systolic blood pressure < 90mm Hg and underwent FAST were analysed. Results were compared with findings at laparotomy. A therapeutic laparotomy (T-LAP) was defined as an abdominal operation within 6 hours in which a definitive procedure was performed. The sensitivity and specificity of FAST were calculated. Results The cohort included 317 patients that underwent FAST (108 positive, 209 negative). T-LAP was performed in 69% (n=75) of FAST(+) patients and 22% (n=48) of FAST(-) patients. FAST had a sensitivity of 62% and specificity of 83%. Conclusions In our multicenter cohort, 22% of FAST(-) patients underwent T-LAP within 6 hours of admission. In hypotensive patients with a negative FAST, clinicians should still maintain a high index of suspicion for significant abdominal hemorrhage. Level of evidence Level IV.

AB - Background The ability of focused assessment with sonography for trauma (FAST) to detect clinically significant hemorrhage in hypotensive injured patients remains unclear. We sought to describe the sensitivity and specificity of FAST using findings at laparotomy as the confirmatory test. Methods Patients from the Prospective Observational Multicenter Major Trauma Transfusion (PROMMTT) study that had a systolic blood pressure < 90mm Hg and underwent FAST were analysed. Results were compared with findings at laparotomy. A therapeutic laparotomy (T-LAP) was defined as an abdominal operation within 6 hours in which a definitive procedure was performed. The sensitivity and specificity of FAST were calculated. Results The cohort included 317 patients that underwent FAST (108 positive, 209 negative). T-LAP was performed in 69% (n=75) of FAST(+) patients and 22% (n=48) of FAST(-) patients. FAST had a sensitivity of 62% and specificity of 83%. Conclusions In our multicenter cohort, 22% of FAST(-) patients underwent T-LAP within 6 hours of admission. In hypotensive patients with a negative FAST, clinicians should still maintain a high index of suspicion for significant abdominal hemorrhage. Level of evidence Level IV.

UR - http://www.scopus.com/inward/record.url?scp=85061226205&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85061226205&partnerID=8YFLogxK

U2 - 10.1136/tsaco-2018-000207

DO - 10.1136/tsaco-2018-000207

M3 - Article

C2 - 30793035

AN - SCOPUS:85061226205

VL - 4

JO - Trauma Surgery and Acute Care Open

JF - Trauma Surgery and Acute Care Open

SN - 2397-5776

IS - 1

M1 - e000207

ER -