Advertisement

Prehospital and Emergency Department Ultrasound in Blunt Abdominal Trauma

  • Miriam Ruesseler
  • Thomas Kirschning
  • Raoul Breitkreutz
  • Ingo Marzi
  • Felix Walcher
Focus on Ultrasound in Trauma and Emergency Surgery

Abstract

Blunt abdominal trauma is a challenging aspect of trauma management. Early detection has a major impact on patient outcome. In contrast to physical examination, computed tomography is known to be a sensitive and specific test for blunt abdominal injuries. However, it is time-consuming and thus contraindicated in hemodynamically unstable patients. Therefore, focused assessment with sonography for trauma (FAST) offers a fast and easily applicable screening method to identify patients for urgent laparotomy without any further diagnostics. FAST detects, with high sensitivity, intraperitoneal fluid that accumulates in dependent areas indicating blunt abdominal trauma. FAST has been established as a gold standard early screening method for blunt abdominal trauma when performing trauma management in the emergency department (ED) based on the Advanced Trauma Life Support® algorithm. The development of hand-held ultrasound devices facilitated the introduction of FAST into prehospital trauma management. It was demonstrated that prehospital FAST (p-FAST) can be performed with high sensitivity and specificity, and can lead to significant changes in prehospital trauma therapy and management. Standardized training with both theoretical and hands-on modules is mandatory in order to gain the skills required to perform FAST or p-FAST well.

Key Words

FAST Abdominal trauma Ultrasound 

References

  1. 1.
    Nast-Kolb D, Waydhas C, Kastl S, Duswald K-H, Schweiberer L. The role of an abdominal injury in follow-up of polytrauma patients. Chirurg 1993;64:552–9.PubMedGoogle Scholar
  2. 2.
    Blaivas M, Sierzenski P, Theodoro D. Significant hemoperitoneum in blunt trauma victims with normal signs in clinical examination. Am J Emerg Med 2002;20:218–21.CrossRefPubMedGoogle Scholar
  3. 3.
    Schurink GW, Bode PJ, van Luijt PA, van Vugt AB. The value of physical examination in the diagnosis of patients with blunt abdominal trauma: a retrospective study. Injury 1997;28:261–5.CrossRefPubMedGoogle Scholar
  4. 4.
    Root HD, Hauser CW, McKinley CR, Lafave JW, Mendiola RP. Diagnostic peritoneal lavage. Surgery 1965;57:633–7.PubMedGoogle Scholar
  5. 5.
    Boulanger B, McLellan B. Blunt abdominal trauma. Emerg Med Clin North Am 1996;14:151–71.CrossRefPubMedGoogle Scholar
  6. 6.
    Kristensen JK, Buemann B, Kuhl E. Ultrasonic scanning in the diagnosis of splenic haematomas. Acta Chir Scand 1971;137:653–657.PubMedGoogle Scholar
  7. 7.
    Scalea TM, Rodriguez A, Chiu WC, Brenneman FD, Fallon WF, Jr., Kato K, McKenney MG, Nerlich ML, Ochsner MG, Yoshii H. Focused assessment with sonography for trauma (FAST): results from an international consensus conference. J Trauma 1999;46:466–72.CrossRefPubMedGoogle Scholar
  8. 8.
    Boulanger BR, McLellan BA, Brenneman FD, Wherrett L, Rizoli SB, Culhane J, Hamilton P. Emergent abdominal sonography as a screening test in a new diagnostic algorithm for blunt trauma. J Trauma 1996;40:867–74.CrossRefPubMedGoogle Scholar
  9. 9.
    Wherrett LJ, Boulanger BR, McLellan BA, Brenneman FD, Rizoli SB, Culhane J, Hamilton P. Hypotension after blunt abdominal trauma: the role of emergent abdominal sonography in surgical triage. J Trauma 1996;41:815–20.CrossRefPubMedGoogle Scholar
  10. 10.
    Rozycki GS, Ballard RB, Feliciano DV, Schmidt JA, Pennington SD. Surgeon-performed ultrasound for the assessment of truncal injuries: lessons learned from 1540 patients. Ann Surg 1998;228:557–67.CrossRefPubMedGoogle Scholar
  11. 11.
    Hoffmann R, Nerlich M, Muggia-Sullam M, Pohlemann T, Wippermann B, Regel G, H. T. Blunt abdominal trauma in cases of multiple trauma evaluated by ultrasonography: a prospective analysis of 291 patients. J Trauma 1992;32:452–8.CrossRefPubMedGoogle Scholar
  12. 12.
    Advanced Trauma Life Support (ATLS) for Doctors. Student course manual. 8th edition. Chicago: American College of Surgeons, 2008:14Google Scholar
  13. 13.
    Clarke J, Trooskin S, Doshi P, Greenwald L, Mode C. Time to laparatomy for intra-abdominal bleeding from trauma does affect survival for delays up to 90 minutes. J Trauma 2002;52:420–5.CrossRefPubMedGoogle Scholar
  14. 14.
    Brooks AJ, Price V, Simms M. FAST on operational military deployment. Emerg Med J 2005;22:263–5.CrossRefPubMedGoogle Scholar
  15. 15.
    Kirkpatrick AW, Sirois M, Laupland KB, Goldstein L, Brown DR, Simons RK, Dulchavsky S, Boulanger BR. Prospective evaluation of hand-held focused abdominal sonography for trauma (FAST) in blunt abdominal trauma. Can J Surg 2005;48:453–60.PubMedGoogle Scholar
  16. 16.
    Brooks A, Davies B, Conolly L. Prospective evaluation of hand-held ultrasound in the diagnosis of blunt abdominal trauma. J R Army Med Corps 2002;148:19–21.PubMedGoogle Scholar
  17. 17.
    Brooks A, Davies B, Smethhurst M, Connolly L. Prospective evaluation of non-radiologist performed emergency abdominal ultrasound for haemoperitoneum. J Emerg Med 2004;21:580–1.Google Scholar
  18. 18.
    Walcher F, Kortum S, Kirschning T, Weihgold N, Marzi I. Optimized management of polytraumatized patients by prehospital ultrasound. Unfallchirurg 2002;105:986–94.CrossRefPubMedGoogle Scholar
  19. 19.
    Walcher F, Weinlich M, Conrad G, Schweigkofler U, Breitkreutz R, Kirschning T, Marzi I. Prehospital ultrasound imaging improves management of abdominal trauma. Br J Surg 2006;93:238–42.CrossRefPubMedGoogle Scholar
  20. 20.
    Grossman DC, Kim A, Macdonald SC, Klein P, Copass MK, Maier RV. Urban-rural differences in prehospital care of major trauma. J Trauma 1997;42:723–9.CrossRefPubMedGoogle Scholar
  21. 21.
    Lapostolle F, Petrovic T, Lenoir G, Catineau J, Galinksi M, Metzger J, Chanzy E, Adnet F. Usefulness of hand-held ultrasound devices in out-of-hospital diagnosis performed by emergency physicians. Am J Emerg Med 2006;24:237–42.CrossRefPubMedGoogle Scholar
  22. 22.
    Frezza E, Solis R, Silich R, Spence R, Martin M. Competency-based instuction to improve the surgical technique and accuracy of the trauma ultrasound. Am Surg 1999;65:884–8.PubMedGoogle Scholar
  23. 23.
    Shackford SR, Rogers FB, Osler TM, Trabulsy ME, Clauss DW, Vane DW. Focused abdominal sonogram for trauma: the learning curve of nonradiologist clinicians in detecting hemoperitoneum. J Trauma 1999;46:553–62.CrossRefPubMedGoogle Scholar
  24. 24.
    Smith RS, Kern SJ, Fry WR, Helmer SD. Institutional learning curve of surgeon-performed trauma ultrasound. Arch Surg 1998;133:530–5.CrossRefPubMedGoogle Scholar
  25. 25.
    Soundappan SV, Holland AJ, Cass DT, Lam A. Diagnostic accuracy of surgeon-performed focused abdominal sonography (FAST) in blunt paediatric trauma. Injury 2005;36:970–5.CrossRefPubMedGoogle Scholar
  26. 26.
    Gracias VH, Frankel H, Gupta R, Reilly PM, Gracias F, Klein W, Nisenbaum H, Schwab CW. The role of positive examinations in training for the focused assessment sonogram in trauma (FAST) examination. Am Surg 2002;68:1008–11.PubMedGoogle Scholar
  27. 27.
    Boulanger BR, Brenneman FD, McLellan BA, Rizoli SB, Culhane J, Hamilton P. A prospective study of emergent abdominal sonography after blunt trauma. J Trauma 1995;39:325–30.CrossRefPubMedGoogle Scholar
  28. 28.
    Brown MA, Casola G, Sirlin CB, Patel NY, Hoyt DB. Blunt abdominal trauma: screening us in 2,693 patients. Radiology 2001;218:352–8.PubMedGoogle Scholar
  29. 29.
    Tso P, Rodriguez A, Cooper C, Militello P, Mirvis S, Badellino MM, Boulanger BR, Foss FA Jr, Hinson DM, Mighty HE, et al. Sonography in blunt abdominal trauma: a preliminary progress report. J Trauma 1992;33:39–43.CrossRefPubMedGoogle Scholar
  30. 30.
    Busch M. Portable ultrasound in pre-hospital emergencies: a feasibility study. Acta Anaesthesiol Scand 2006;50:754–8.CrossRefPubMedGoogle Scholar

Copyright information

© Springer 2009

Authors and Affiliations

  • Miriam Ruesseler
    • 1
    • 3
  • Thomas Kirschning
    • 2
  • Raoul Breitkreutz
    • 2
  • Ingo Marzi
    • 1
  • Felix Walcher
    • 1
  1. 1.Department of Trauma SurgeryJohann Wolfgang Goethe-UniversityFrankfurtGermany
  2. 2.Department of Anesthesiology, Intensive Care Medicine and Pain TherapyJohann Wolfgang Goethe-UniversityFrankfurtGermany
  3. 3.Department of Trauma SurgeryJohann Wolfgang Goethe-UniversityFrankfurtGermany

Personalised recommendations