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Zheng Y, Li Z, Zhou Q. Diagnosis of small intestinal microperforation by cell morphology detection in abdominal puncture fluid: A case report. Int J Surg Case Rep 2024; 115:109316. [PMID: 38306870 PMCID: PMC10847150 DOI: 10.1016/j.ijscr.2024.109316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Revised: 01/24/2024] [Accepted: 01/25/2024] [Indexed: 02/04/2024] Open
Abstract
INTRODUCTION AND IMPORTANCE Although abdominal computed tomography angiography (CTA) may be a gold standard for early diagnosis of small intestinal microperforation, early missed and delayed diagnosis are often important factors leading to poor prognosis. The cellular morphology diagnosis of abdominal puncture fluid (DAPF) or diagnostic peritoneal lavage (DPL) may have unexpected clinical outcomes. CASE PRESENTATION We report a case of small bowel microperforation which dues to BAT. A 39-year-old male with a chief complaint of "multiple injuries to the whole body from a car accident within 7 hours" was admitted to the trauma center. The first abdominal CTA ruled out perforation of abdominal parenchymatous organs and gastrointestinal tract. Subsequently, the patient underwent emergency surgery for traumatic shock, followed by clinical manifestations of persistent fever and septic shock. After diagnostic abdominal puncture fluid cell morphology examination, intestinal perforation was first considered. CLINICAL DISCUSSION Routine examination of abdominal puncture fluid can usually roughly determine the condition of visceral trauma, especially quickly and conveniently determine whether there is intra-peritoneal bleeding. However specific diagnostic components which were found in the cell images of abdominal puncture fluid also showed the clinical value of cellular morphology of DAPF. CONCLUSION The cellular morphology examination of DAPF/DPL may be the simplest, fastest, and most effective method for diagnosing small intestinal perforation due to blunt abdominal trauma(BAT). The value of DAPF /DPL in traumatic gastrointestinal injury cannot be ignored, especially for patients with BAT.
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Affiliation(s)
- Yaqin Zheng
- Clinical laboratory centre of Longquan People's Hospital Affiliated to Lishui University, Longquan City, Zhejiang Province, China
| | - Zijun Li
- Department of Obstetric and Gynecology of Longquan People's Hospital Affiliated to Lishui University, Longquan City, Zhejiang Province, China.
| | - Qinbing Zhou
- Imagning diagnosis center of Zhejiang Quhua Hospital, Quzhou city, Zhejiang province, China
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Samuel AE, Chakrapani A, Moideen F. Accuracy of Extended Focused Assessment with Sonography in Trauma (e-FAST) Performed by Emergency Medicine Residents in a Level One Tertiary Center of India. ADVANCED JOURNAL OF EMERGENCY MEDICINE 2018; 2:e15. [PMID: 31172078 PMCID: PMC6549052 DOI: 10.22114/ajem.v0i0.69] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
INTRODUCTION It could be claimed that extended focused assessment with sonography for trauma (e-FAST) is the most important use of ultrasound in every emergency department (ED). It is a rapid, repeatable, non-invasive bedside method that was designed to answer one single question, which is, "whether free fluid is present in the peritoneal, pleural and pericardial cavity or not?" This examination may also be used to evaluate the lungs for pneumothorax. OBJECTIVE The current comparative study was conducted to assess the accuracy and reproducibility of e-FAST performed by emergency medicine residents (EMRs) and radiology consultants (RCs) in multiple trauma patients. METHOD This diagnostic accuracy study was conducted prospectively in patients presenting over a period of 12 months from January 1, 2013, to December 31, 2013 to the ED of Kerala Institute of Medical Sciences (KIMS), Kerala, India. All multiple trauma patients older than 18 years of age presenting within 24 hours of their traumatic event, who underwent both e-FAST and thoracoabdominal computed tomography (CT) scan were included. The e-FAST exams were first performed by the EMRs and then by RCs. The thoracoabdominal CT scan findings were considered as the gold standard. The results were compared between both groups to assess the inter-observer variability. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy were calculated both for EMRs and RCs. RESULTS In the study period, 150 patients with a mean age of 42.06 ± 18.1 years were evaluated (76.7% male). Only 19 cases (12.7%) had a history of fall from a height, and the others were admitted due to RTA. Thirty-four cases (22.7%) did not require surgery; but the others underwent various interventions. Both EMRs and RCs reported positive findings in 20 cases (13.3%) and negative findings in 130 cases (86.7%). The correlation of e-FAST done by EMRs with that by RCs was 100%. E-FAST exam had a sensitivity of 90.4%, specificity 99.2%, PPV 95.0%, NPV 98.4%, and accuracy 98%, both for EMRs and RCs. CONCLUSION Based on the findings, the sensitivity, specificity, and accuracy of e-FAST exams performed by EMRs were equal to those performed by RCs. It seems that e-FAST performed by EMRs were almost accurate during the initial trauma resuscitation in the ED of a level one trauma center in India.
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Affiliation(s)
- Arpith Easo Samuel
- Department of Emergency Medicine, Kerala Institute of Medical Sciences, Kerala, India
| | - Anoop Chakrapani
- Department of Emergency Medicine, Kerala Institute of Medical Sciences, Kerala, India
| | - Fabith Moideen
- Department of Emergency Medicine, Baby Memorial Hospital, Kerala, India
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Elbaih AH, Abu-Elela ST. Predictive value of focused assessment with sonography for trauma (FAST) for laparotomy in unstable polytrauma Egyptians patients. Chin J Traumatol 2017; 20:323-328. [PMID: 29223612 PMCID: PMC5832486 DOI: 10.1016/j.cjtee.2017.09.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2017] [Revised: 06/08/2017] [Accepted: 09/08/2017] [Indexed: 02/04/2023] Open
Abstract
PURPOSE The emergency physicians face significant clinical uncertainty when multiple trauma patients arrive in the emergency department (ED). The priorities for assessment and treatment of polytrauma patients are established in the primary survey. Focused assessment with sonography for trauma (FAST) is very essential clinical skill during trauma resuscitation. Use of point of care ultrasound among the trauma team working in the primary survey in emergency care settings is lacking in Suez Canal University Hospitals even ultrasound machine not available in ED. This study aims to evaluate the accuracy of FAST in hemodynamically unstable polytraumatized patients and to determine its role as an indication of laparotomy. METHODS This study is a cross-sectional study included 150 polytrauma patients with a blunt mechanism admitted in Suez Canal University Hospital. Firstly primary survey by airway check, cervical spine securing with neck collar, maintenance of breathing/circulation and management of life threading conditions if present were conducted accordingly to ATLS (advanced trauma life support) guidelines. The patients were assessed in the primary survey using the FAST as a tool to determine the presence of intra-abdominal collection. RESULTS A total of 150 patients, and FAST scans were performed in all cases. The sensitivity and specificity were 92.6% and 100%, respectively. The negative predictive value was 92%, while the positive predictive value of FAST was 100%. The accuracy of FAST was 96%. CONCLUSION FAST is an important method to detect intra-abdominal fluid in the initial assessment in hemodynamically unstable polytrauma patients with high accuracy.
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Affiliation(s)
- Adel Hamed Elbaih
- Department of Emergency Medicine, Faculty of Medicine, Suez Canal University, Ismailia, Egypt,Corresponding author.
| | - Sameh T. Abu-Elela
- Department of General Surgery, Faculty of Medicine, Suez Canal University, Ismailia, Egypt
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Bhoi S, Sinha TP, Ramchandani R, Kurrey L, Galwankar S. To determine the accuracy of focused assessment with sonography for trauma done by nonradiologists and its comparative analysis with radiologists in emergency department of a level 1 trauma center of India. J Emerg Trauma Shock 2013; 6:42-6. [PMID: 23493113 PMCID: PMC3589858 DOI: 10.4103/0974-2700.106324] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2011] [Accepted: 01/12/2012] [Indexed: 11/22/2022] Open
Abstract
Background: Focused assessment with sonography for trauma (FAST) is an important skill during trauma resuscitation. Use of point of care ultrasound among the trauma team working in emergency care settings is lacking in India. Objective: To determine the accuracy of FAST done by nonradiologists (NR) when compared to radiologists during primary survey of trauma victims in the emergency department of a level 1 trauma center in India. Materials and Methods: A prospective study was done during primary survey of resuscitation of nonconsecutive patients in the resuscitation bay. The study subjects included NR such as one consultant emergency medicine, two medicine residents, one orthopedic resident and one surgery resident working as trauma team. These subjects underwent training at 3-day workshop on emergency sonography and performed 20 supervised positive and negative scans for free fluid. The FAST scans were first performed by NR and then by radiology residents (RR). The performers were blinded to each other's sonography findings. Computed tomography (CT) and laparotomy findings were used as gold standard whichever was feasible. Results were compared between both the groups. Intraobserver variability among NR and RR were noted. Results: Out of 150 scans 144 scans were analyzed. Mean age of the patients was 28 [1-70] years. Out of 24 true positive patients 18 underwent CT scan and exploratory laparotomies were done in six patients. Sensitivity of FAST done by NR and RR were 100% and 95.6% and specificity was 97.5% in both groups. Positive predictive value among NR and RR were 88.8%, 88.46% and negative predictive value were 97.5% and 99.15%. Intraobserver performance variation ranged from 87 to 97%. Conclusion: FAST performed by NRs is accurate during initial trauma resuscitation in the emergency department of a level 1 trauma center in India.
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Affiliation(s)
- Sanjeev Bhoi
- Department of Emergency Medicine, AIIMS Trauma Centre, New Delhi, India
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Rhodes CM, Smith HL, Sidwell RA. Utility and relevance of diagnostic peritoneal lavage in trauma education. JOURNAL OF SURGICAL EDUCATION 2011; 68:313-317. [PMID: 21708370 DOI: 10.1016/j.jsurg.2011.02.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/20/2010] [Revised: 01/24/2011] [Accepted: 02/08/2011] [Indexed: 05/31/2023]
Abstract
OBJECTIVES During the last 2 decades, the advent of new technologies in trauma patient care may have resulted in a decreased number of diagnostic peritoneal lavage (DPL) evaluations. In this study, it is hypothesized that fewer DPL are being performed at a midwestern trauma center. Such negative trends may make the inclusion of DPL in current trauma education potentially outdated and no longer universally appropriate in trauma evaluation algorithms. DESIGN, SETTING, AND PARTICIPANTS This retrospective observational study of a level I trauma center includes patients from January 1998 through September 2010. The total number of trauma-related DPL procedures performed annually during the study period was determined along with accompanying facility and trauma patient level data. RESULTS A total of 24 DPLs were performed at the target trauma center during the study period. There was a significant decrease (p = 0.0018) in the use of DPL despite a significant increase (p < 0.0001) in the proportion of trauma patients with an injury severity score > 15. CONCLUSIONS Study data demonstrated a decrease in the use of DPL as a diagnostic modality in the evaluation of blunt abdominal trauma patients at a medium-sized midwestern center. These data provide historic facility-level evidence of a practice change. Such information may support a recommendation that the American College of Surgeons revisit its current curriculum for Advanced Trauma Life Support (ATLS). Specifically, we propose the American College of Surgeons consider changing DPL instruction to an optional component of ATLS. COMPETENCIES: Patient Care, Medical Knowledge, Practice Based Learning and Improvement.
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Affiliation(s)
- Connie M Rhodes
- Department of Surgery Education, Iowa Methodist Medical Center, Des Moines, Iowa 50309-1453, USA
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PARIS A, NHAN T, CORNET E, PEROL JP, MALET M, TROUSSARD X. ORIGINAL ARTICLE: Performance evaluation of the body fluid mode on the platform Sysmex XE-5000 series automated hematology analyzer. Int J Lab Hematol 2010; 32:539-47. [DOI: 10.1111/j.1751-553x.2010.01220.x] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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Wening JV, Tesch C, Huhnholz J, Friemert B. [The value of sonography in traumatology and orthopedics : Part 2: emergency diagnostics in blunt abdominal and thoracic trauma]. Unfallchirurg 2008; 111:958-64, 966-7. [PMID: 19039569 DOI: 10.1007/s00113-008-1440-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Ultrasound examinations in trauma patients should be done in the emergency department using curved-array (3.5-7.5 MHz) probes. Blunt trauma of the abdomen and thorax must be regarded as a single organ injury. Sonography is the imaging technique of first choice and has completely replaced peritoneal lavage. Paramount advantages are its ability to provide rapid information and reproducible results at short intervals and in a noninvasive manner. The sensitivity and specificity of sonography in detecting intraabdominal fluid are 97-100% and 80-90%, respectively. To achieve such good results, though, adequate education in ultrasound and state-of-the-art devices is crucial. Clinical experiences prove that standardized sonography must be part of polytrauma management and should be integrated in advanced trauma life support courses. Technical improvements with better image quality and miniaturization of hardware will contribute to increase the use of this technique. However, ultrasound does not replace computed tomography for follow-up in answering more sophisticated questions in multiple injured patients.
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Affiliation(s)
- J V Wening
- Hand-und Wiederherstellungschirurgie, Asklepiosklinik Altona, 22763, Hamburg, Deutschland.
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Watson NFS, Hammond JS, Brooks A, Abercrombie JF, Maxwell-Armstrong CA. Blunt abdominal trauma: Note of caution on diagnostic peritoneal lavage. BMJ 2008; 336:1086. [PMID: 18483024 PMCID: PMC2386648 DOI: 10.1136/bmj.39577.450741.3a] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Bhan C, Forshaw MJ, Bew DP, Kapadia YK. Diagnostic peritoneal lavage and ultrasonography for blunt abdominal trauma: attitudes and training of current general surgical trainees. Eur J Emerg Med 2007; 14:212-5. [PMID: 17620912 DOI: 10.1097/mej.0b013e3280bef8ba] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE It has been suggested that diagnostic peritoneal lavage is now obsolete in UK hospitals with access to either skilled ultrasonography or emergency physician or surgeon-performed focused abdominal sonography in trauma. Diagnostic peritoneal lavage continues to be advocated and taught on Advanced Trauma Life Support courses. The aim of this study was to evaluate the experiences and attitudes of general-surgery trainees in one UK training region towards diagnostic peritoneal lavage and focused abdominal sonography in trauma in managing blunt abdominal trauma. METHODS An anonymous postal piloted questionnaire was sent to all 66 general surgery specialist trainees in one UK training region between January and March 2005. RESULTS Out of 40 replies to the questionnaire (response rate 61%), 53% and 38% of surgical trainees had either never performed or never observed a diagnostic peritoneal lavage during their training. Thirteen trainees (33%) felt diagnostic peritoneal lavage to be obsolete and would never contemplate using it; 15 trainees (37%) might consider using diagnostic peritoneal lavage if computed tomography or ultrasonography were unavailable. Ten trainees (25%) felt that diagnostic peritoneal lavage had been superseded by computed tomography. Only 12 trainees (30%) had worked in a UK hospital with access to facilities for focused abdominal sonography in trauma and only seven trainees (18%) had received any training or experience in focused abdominal sonography in trauma. CONCLUSIONS Surgical trainees in one UK training region lack skills in both diagnostic peritoneal lavage and focused abdominal sonography in trauma for managing blunt abdominal trauma and are therefore reliant upon the availability of prompt, skilled radiological assistance or emergency physician-provided focused abdominal sonography in trauma.
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Affiliation(s)
- Chetan Bhan
- Department of General Surgery, Kent and Sussex Hospital, Mount Ephraim, Tunbridge Wells, Kent, UK
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Abstract
BACKGROUND General practitioners (GPs) have a role in the early management of major trauma in rural Australia. The Early Management of Severe Trauma (EMST) course fulfils their educational needs by providing skills for the systematic management of the seriously injured patient. However, with any skill there is a natural loss over time. This study surveyed GPs who have completed the EMST course to determine their confidence in trauma management. METHODS A two-page survey was mailed in December 2004 to all GPs who had completed an EMST course from 1989 to 2004 and were currently residing in Western Australia. The survey consisted of background questions, open-ended questions regarding the EMST course and skills confidence ratings using visual analogue scales. The final sample size was 223. RESULTS Response rate was 55%. GPs were least confident in carrying out diagnostic peritoneal lavage and cricothyroidotomy. They were most confident inserting i.v. cannulas and managing fluid replacement. Their confidence in some of these skills were related to the frequency of managing trauma patients but not to the interval since completing the EMST course. GPs found the systematic approach to trauma management and practical/procedural skills as the most relevant components of EMST. They felt that EMST could be improved with more accessible refresher courses and more practical/procedural skills. CONCLUSION Most of these GPs were involved in rural hospital work where they may be required to manage seriously injured patients. They require regular refresher courses to maintain their confidence levels in treating seriously injured patients.
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Affiliation(s)
- Derrick G Lopez
- School of Primary, Aboriginal and Rural Health Care, Discipline of General Practice, Claremont, WA, Australia.
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Kuncir EJ, Velmahos GC. Diagnostic peritoneal aspiration--the foster child of DPL: a prospective observational study. Int J Surg 2006; 5:167-71. [PMID: 17509498 DOI: 10.1016/j.ijsu.2006.06.013] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2006] [Revised: 06/17/2006] [Accepted: 06/20/2006] [Indexed: 11/16/2022]
Abstract
BACKGROUND The abdomen is routinely considered as a possible source of bleeding in hypotensive and unevaluable blunt multitrauma patients. These patients are often unstable to be transported for abdominal computed tomography (CT). Emerging data on Focused Assessment with Sonography for Trauma (FAST) exam questions its initially reported high accuracy. We hypothesized that Diagnostic Peritoneal Aspiration (DPA), without a full lavage, accurately detects intraperitoneal blood if present in sufficient volume to cause hypotension and warrant emergent operation. METHODS Over 24 months (July 2002-June 2004), 62 severe blunt trauma patients (Injury Severity Score: 32+/-17) with admission systolic blood pressure equal to or less than 90 mmHg were enrolled prospectively. Percutaneous DPA was performed after FAST. Aspiration of any quantity of blood was considered a positive test. Sensitivity and specificity of DPA and FAST were calculated against findings from abdominal CT, laparotomy, or autopsy. RESULTS Twenty-two patients (35%) required emergent laparotomy and 39 (63%) died. DPA was performed in less than 1 min with no complications. Sensitivity and specificity of DPA was 89% and 100%, respectively, whereas for FAST it was 50% and 95%. Two (3%) false negative DPA were recorded; one patient had a minor liver laceration with 250 ml of free blood and the other a leaking retroperitoneal pelvic hematoma in the presence of cirrhosis with 600 ml of bloody ascitic fluid. There were no false positive DPA. Nine (14.5%) false negative and two (3%) false positive FAST were recorded in patients who were found to have at laparotomy 1575+/-1070 ml of hemoperitoneum on average. CONCLUSIONS Percutaneous DPA is accurate, rapid, safe, and superior to FAST for the diagnosis of abdominal blood as the source of hemodynamic instability, requiring emergent surgery, in blunt multitrauma patients.
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Affiliation(s)
- Eric J Kuncir
- Division of Trauma and Critical Care, Department of Surgery, University of Southern California, Los Angeles County and University of Southern California Medical Center, Los Angeles, CA, USA
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Abstract
BACKGROUND AND OBJECTIVE Handheld ultrasound, because of its light weight, size, rugged design, and relative simplicity of use is ideal for use on operational military deployment. These machines have been used in the diagnosis of a range of traumatic conditions including abdominal, thoracic, and extremity trauma in the hospital environment, yet few data exist on their use during military operations. This paper presents experience of handheld focused assessment with sonography for trauma (FAST) on operational military deployment. METHOD Over a two month period, handheld FAST was performed by a single surgeon during the circulation phase of the primary survey in trauma patients presenting to the British Military Hospital in Iraq. RESULTS Fifteen from casualties underwent a FAST examination. Ten were victims of blunt trauma, two had received injuries anti-personnel mines, and three had penetrating injuries from ballistic trauma. There was one positive FAST, confirmed at laparotomy as bleeding from a liver injury. Thirteen scans were negative and remained negative on repeat FAST at 6 hours. One further patient with a negative FAST underwent laparotomy because of transectory, there was no intra-abdominal blood or fluid at surgery. CONCLUSION Handheld FAST is a valuable technique for investigating abdominal or thoracic bleeding in single or multiple casualty events on operational military deployment.
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Abstract
OBJECTIVE To gain an overview of the current practice of different major institutions in Taiwan in the evaluation of abdominal injuries. A further comparison was made between general surgeons and emergency physicians in this aspect. METHOD A telephone survey was conducted of all emergency departments of 58 major institutions (14 medical centres, 44 district hospitals) that are capable of providing definitive care for trauma victims in Taiwan in June 2002. Respondents were asked to select the diagnostic modality of choice in the evaluation of a haemodynamically abnormal blunt trauma victim with suspected intra-abdominal injuries. In the same study period, this particular telephone scenario was also used to survey 109 individual doctors (45 emergency physicians, 64 general surgeons). RESULTS Most respondents preferred ultrasound (also known as focused assessment with sonography for trauma or "FAST") instead of diagnostic peritoneal lavage (DPL) because DPL is invasive and most doctors in Taiwan have limited experience in performing DPL or interpreting the results. CONCLUSIONS It seems reasonable to devote greater resources for emergency departments to incorporate a FAST based algorithm into their initial management of trauma victims, and to improve training in its use. It is also suggested that future ATLS teaching in Taiwan should include didactic material on FAST.
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Brooks A, Davies B, Smethhurst M, Connolly J. Prospective evaluation of non-radiologist performed emergency abdominal ultrasound for haemoperitoneum. Emerg Med J 2005; 21:e5. [PMID: 15333573 PMCID: PMC1726410 DOI: 10.1136/emj.2003.006932] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVES To evaluate non-radiologist performed emergency ultrasound for the detection of haemoperitoneum after abdominal trauma in a British accident and emergency department. METHODS Focused assessment with sonography for trauma (FAST) was performed during the primary survey on adult patients triaged to the resuscitation room with suspected abdominal injury over a 12 month period. All investigations were performed by one of three non-radiologists trained in FAST. The ultrasound findings were compared against the investigation of choice of the attending surgeon/accident and emergency physician. The patients were followed up for clinically significant events until hospital discharge or death. RESULTS One hundred patients who had sustained blunt abdominal trauma, were evaluated by FAST. Nine true positive scans were detected and confirmed by computed tomography, diagnostic peritoneal lavage, or laparotomy. There was one false positive in this group, giving a sensitivity of 100%, specificity 99%, and positive predictive value of 90%. Ten patients with penetrating injuries were evaluated with a sensitivity and specificity for FAST of 33% and 86% respectively. CONCLUSIONS Emergency torso ultrasound for the detection of haemoperitoneum can be successfully performed by trained non-radiologists within a British accident and emergency system. It is an accurate and rapid investigation for blunt trauma, but the results should be interpreted with caution in penetrating injury.
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Affiliation(s)
- A Brooks
- Department of Surgery, Queens Medical Centre, University Hospital, Nottingham NG7 2UH, UK.
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