Double Jeopardy in Penetrating Trauma: Get FAST, Get It Right

Area of Science:

• Trauma Surgery
• Emergency Medicine
• Diagnostic Imaging

Background:

• Hypotensive patients with thoracoabdominal penetrating injuries present a surgical dilemma regarding cavity exploration.
• The Focused Assessment with Sonography for Trauma (FAST) is a potential tool to guide these decisions.

Purpose of the Study:

• To evaluate the accuracy of FAST in determining the need and sequence of cavity exploration in patients with thoracoabdominal penetrating injuries.

Main Methods:

• A 4-year retrospective study at a level 1 trauma center.
• Inclusion of patients with multi-cavity thoracoabdominal injuries based on external wounds.
• Evaluation of pericardial and abdominal FAST accuracy against operative or CT findings.

Main Results:

• Out of 2851 penetrating injury patients, 103 met inclusion criteria.
• Pericardial FAST showed 92.3% sensitivity for cardiac injuries.
• Abdominal FAST had 68.5% sensitivity and 93.9% specificity.

Conclusions:

• Pericardial FAST is highly sensitive for detecting the need for pericardial exploration.
• Positive abdominal FAST warrants laparotomy, but negative results do not rule out abdominal bleeding.