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

    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

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    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{d919d7819b3e456a8be45e2acd1cf2a1,
    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 Susan Rowell and Barbosa, {Ronald R.} and Holcomb, {John B.} and Fox, {Erin E.} and Barton, {Cassie A.} and Martin Schreiber 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 Karen Brasel 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 Myers, {John G.} and Stewart, {Ronald M.}",
    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

    AU - Barbosa, Ronald R.

    AU - Holcomb, John B.

    AU - Fox, Erin E.

    AU - Barton, Cassie A.

    AU - Schreiber, Martin

    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 - Brasel, Karen

    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 - Myers, John G.

    AU - Stewart, Ronald M.

    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.

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    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

    VL - 4

    JO - Trauma Surgery and Acute Care Open

    JF - Trauma Surgery and Acute Care Open

    SN - 2397-5776

    IS - 1

    M1 - e000207

    ER -