| Description |
Organ injury in blunt trauma requires rapid diagnosis to obtain the best outcome, and the optimal means of diagnosis continues to be refined. The focused abdominal sonography in trauma (FAST) examination was initially developed to help rapidly identify those blunt trauma patients who require emergent laparotomy. Since first validated in these patients, the clinical use of the FAST exam has expanded to include all trauma patients generally. When applied to hemodynamically stable blunt trauma patients, the FAST exam is less sensitive for detecting internal injury, and particularly for detecting the need for laparotomy. Combining FAST results with a measure of hemodynamic stability might better predict the need for emergent laparotomy as a therapeutic intervention and thus give a more meaningful predictive value to the positive test. In this study, determination was made as to whether a first measured shock index of > 1, when combined with a positive FAST examination, better predicts the need for therapeutic laparotomy in blunt trauma patients than FAST alone. If validated, such a rule might be used as a decision support element of a computerized clinical point-of-care documentation tool for the traumatically injured. We performed a retrospective, case-control study to evaluate the predictive value of shock index and FAST exam on blunt trauma patients. Data were obtained from an American College of Surgeons-verified Level One trauma center during the year 2003. Patients were included in the study if they were injured by blunt mechanism and if they required the highest level of trauma team activation by standardized institutional criteria. Patients were excluded if they had prior diagnostic peritoneal lavage (DPL) or transfusion, or were less than 14 years of age. The lowest of first emergency department and pre-hospital-recorded values for heart rate and systolic blood pressure were used to calculate the shock index. Four hundred ninety-one patients were included in the study, 27 of whom underwent emergent laparotomy (rate 5.50%). Two of these laparotomies were classified as nontherapeutic."" 344 patients had FAST results recorded for analysis. The sensitivity of a positive FAST exam plus shock index > 1 for therapeutic laparotomy was 44.0% (95% CI 26.3-62.8%), specificity 99.4% (95% CI 98.0-99,9%). Comparing the predictive values of the two tests yielded: +FAST, SI > 1 = 74%; +FAST, SI< 1 = 24%, -FAST, SI > 1 = 15%, -FAST, SI< 1 = 1% (each at p < 0.01). Results of both predictive tests were obtained using computerized data."" |
