Accuracy of FAST in detecting intraabdominal bleeding in major trauma with pelvic and/or acetabular fractures: a retrospective cohort study

Lasse Rehné Jensen, Emma Possfelt-Møller, Allan Evald Nielsen, Upender Martin Singh, Lars Bo Svendsen, Luit Penninga*

*Corresponding author for this work

Abstract

PURPOSE: The Focused Assessment with Sonography for Trauma (FAST) is a tool to rapidly detect intraabdominal and intrapericardial fluid with point-of-care ultrasound. Previous studies have questioned the role of FAST in patients with pelvic fractures. The aim of the present study was to assess the accuracy of FAST to detect clinically significant intraabdominal hemorrhage in patients with pelvic fractures.

METHODS: We included all consecutive patients with pelvic and/or acetabular fractures treated our Level 1 trauma center from 2009-2020. We registered patient and fracture characteristics, FAST investigations and CT descriptions, explorative laparotomy findings, and transfusion needs. We compared FAST to CT and laparotomy findings, and calculated true positive and negative findings, sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV).

RESULTS: We included 389 patients. FAST had a sensitivity of 75%, a specificity of 98%, a PPV of 84%, and a NPV of 96% for clinically significant intraabdominal bleeding. Patients with retroperitoneal hematomas were at increased risk for laparotomy both because of True-negative FAST and False-positive FAST.

CONCLUSION: FAST is accurate to identify clinically significant intraabdominal blood in patients with severe pelvic fractures and should be a standard asset in these patients. Retroperitoneal hematomas challenge the FAST interpretation and thus the decision making when applying FAST in patients with pelvic fractures.

Original languageEnglish
JournalEuropean Journal of Orthopaedic Surgery & Traumatology
Volume34
Issue number3
Pages (from-to)1479-1486
Number of pages8
ISSN1633-8065
DOIs
Publication statusPublished - Apr 2024

Keywords

  • Fractures, Bone/complications
  • Hematoma/complications
  • Hemoperitoneum/etiology
  • Hip Fractures/complications
  • Humans
  • Pelvic Bones/diagnostic imaging
  • Retrospective Studies
  • Sensitivity and Specificity
  • Spinal Fractures/complications
  • Wounds, Nonpenetrating/complications
  • Transfusions
  • Bleeding
  • Pelvic Fractures
  • FAST
  • Laparotomy

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