- Email: [email protected]
FAST exam in severely injured patients
Letters to the Editor / Injury, Int. J. Care Injured 41 (2010) 974–979
Isabelle Rouquette Department of Anesthesia, Hospital Saint Joseph, 185, Rue Raymond Losserand, 75674 Paris, France Francois Trueba Yves Auroy Yves Diraison Department of Intensive Care, Military Hospital Val de Graˆce, Secre´tariat de Re´animation, 74 Boulevard Port Royal, 75005 Paris, France *Corresponding author. Tel.: +33 664442525; fax: +33 140514608 E-mail address: [email protected]
doi:10.1016/j.injury.2010.03.012
Letter to the Editor FAST exam in severely injured patients Editor, I read the recent publication by Becker et al. with a great interest. Becker et al. concluded that ‘‘Patients with high ISS are at increased risk of having ultrasound-occult injuries and have a lower accuracy of their ultrasound examination than patients with low and moderate ISS.1’’ Of interest, this report is totally discordant with the previous reports by Soundappan et al.2 and Thourani et al.3. Soundappan et al. reported that ‘‘Surgeon-performed FAST for BAT was safe and accurate with a high specificity. It would seem a potentially valuable tool in the evaluation of paediatric blunt trauma victims for free fluid within the peritoneal cavity.2’’ There are some concerns about these two works. Although the populations in the different studies are not same but the difference in results might be due to other factors such as the experience of the practitioners who perform FAST. For the trauma team, training on FAST might help improve the efficacy in using FAST in real practice. Conflict of interest None.
979
Author’s reply Reply to ‘‘Is the FAST exam reliable in severely injured patients?’’ Dear Prof. Wiwanitkit, Thank you for your valuable response to the manuscript ‘‘Is the FAST exam reliable in severely injured patients?’’. It is commonly agreed that FAST has an important role as a primary diagnostic tool in hypotensive patients with blunt trauma. In many trauma centers, FAST has become an integral part of the primary assessment of patients with blunt trauma. Many investigators concluded that FAST, which has the primary role of detecting free fluid as a marker of injury, is a very useful and safe modality. On the other hand, it is very important to know the limitations of this diagnostic tool in different clinical settings (e.g. blunt abdominal trauma and pelvic, rib and spinal fractures, existence of subcutaneous emphysema, etc.). We found that FAST, in stable blunt trauma patients with high grade injury, has low accuracy and cannot be used as a sole modality to exclude intra-abdominal injury in this cohort of trauma patients. As you rightly noted, the populations in our study and those in Soundappan et al. were different [1] – adult versus pediatric. The mean ISS was 23 in our study and 6 in the latter. We cannot explain why FAST in patients with a high ISS has lower accuracy than in patients with low and moderate ISS. Whatever the reason, residents, trauma fellows and attending surgeons in the institution were the study was performed are well trained and accredited in FAST examination. There have been quite a number of publications showing a good correlation between surgeon and radiologist performed FAST examination [2]. Obviously, further prospective studies are needed to establish the exact role of FAST examinations in different cohorts of stable blunt trauma patients. References [1] Soundappan SV, Holland AJ, Cass DT, Lam A. Diagnostic accuracy of surgeonperformed focused abdominal sonography (FAST) in blunt paediatric trauma. Injury 2005 Aug;36(8):970–5. [2] Thourani VH, Pettitt BJ, Schmidt JA, Cooper WA, Rozycki GS. Validation of surgeon-performed emergency abdominal ultrasonography in pediatric trauma patients. J Pediatr Surg 1998 Feb;33(2):322–8.
Alexander Beckera,b,* Department of Surgery A, Haemek Medical Center, Afula, B. Rappaport School of Medicine, Technion, Haifa, Israel b DeWitt Daughtry Family Department of Surgery, Division of Trauma and Critical Care, Ryder Trauma Center, Miller School of Medicine University, Miami, Florida, USA a
References 1. Becker A, Lin G, McKenney MG, et al. Is the FAST exam reliable in severely injured patients? Injury )2009;(November) [Epub ahead of print]. 2. Soundappan SV, Holland AJ, Cass DT, Lam A. Diagnostic accuracy of surgeonperformed focused abdominal sonography (FAST) in blunt paediatric trauma. Injury 2005;36(August (8)):970–5. 3. Thourani VH, Pettitt BJ, Schmidt JA, et al. Validation of surgeon-performed emergency abdominal ultrasonography in pediatric trauma patients. J Pediatr Surg 1998;3(February (2)):322–8.
Viroj Wiwanitkit* Wiwanitkit House, Bangkhae, Bangkok 10160, Thailand *Tel.: +6624132436 E-mail address: [email protected]
*Correspondence address: Department of Surgery A, Haemek Medical Center, Afula, Israel. Tel.: +972 4 6494327 E-mail address: [email protected] (A. Becker) doi:10.1016/j.injury.2010.05.031
doi:10.1016/j.injury.2010.05.029
Isabelle Rouquette Department of Anesthesia, Hospital Saint Joseph, 185, Rue Raymond Losserand, 75674 Paris, France Francois Trueba Yves Auroy Yves Diraison Department of Intensive Care, Military Hospital Val de Graˆce, Secre´tariat de Re´animation, 74 Boulevard Port Royal, 75005 Paris, France *Corresponding author. Tel.: +33 664442525; fax: +33 140514608 E-mail address: [email protected]
doi:10.1016/j.injury.2010.03.012
Letter to the Editor FAST exam in severely injured patients Editor, I read the recent publication by Becker et al. with a great interest. Becker et al. concluded that ‘‘Patients with high ISS are at increased risk of having ultrasound-occult injuries and have a lower accuracy of their ultrasound examination than patients with low and moderate ISS.1’’ Of interest, this report is totally discordant with the previous reports by Soundappan et al.2 and Thourani et al.3. Soundappan et al. reported that ‘‘Surgeon-performed FAST for BAT was safe and accurate with a high specificity. It would seem a potentially valuable tool in the evaluation of paediatric blunt trauma victims for free fluid within the peritoneal cavity.2’’ There are some concerns about these two works. Although the populations in the different studies are not same but the difference in results might be due to other factors such as the experience of the practitioners who perform FAST. For the trauma team, training on FAST might help improve the efficacy in using FAST in real practice. Conflict of interest None.
979
Author’s reply Reply to ‘‘Is the FAST exam reliable in severely injured patients?’’ Dear Prof. Wiwanitkit, Thank you for your valuable response to the manuscript ‘‘Is the FAST exam reliable in severely injured patients?’’. It is commonly agreed that FAST has an important role as a primary diagnostic tool in hypotensive patients with blunt trauma. In many trauma centers, FAST has become an integral part of the primary assessment of patients with blunt trauma. Many investigators concluded that FAST, which has the primary role of detecting free fluid as a marker of injury, is a very useful and safe modality. On the other hand, it is very important to know the limitations of this diagnostic tool in different clinical settings (e.g. blunt abdominal trauma and pelvic, rib and spinal fractures, existence of subcutaneous emphysema, etc.). We found that FAST, in stable blunt trauma patients with high grade injury, has low accuracy and cannot be used as a sole modality to exclude intra-abdominal injury in this cohort of trauma patients. As you rightly noted, the populations in our study and those in Soundappan et al. were different [1] – adult versus pediatric. The mean ISS was 23 in our study and 6 in the latter. We cannot explain why FAST in patients with a high ISS has lower accuracy than in patients with low and moderate ISS. Whatever the reason, residents, trauma fellows and attending surgeons in the institution were the study was performed are well trained and accredited in FAST examination. There have been quite a number of publications showing a good correlation between surgeon and radiologist performed FAST examination [2]. Obviously, further prospective studies are needed to establish the exact role of FAST examinations in different cohorts of stable blunt trauma patients. References [1] Soundappan SV, Holland AJ, Cass DT, Lam A. Diagnostic accuracy of surgeonperformed focused abdominal sonography (FAST) in blunt paediatric trauma. Injury 2005 Aug;36(8):970–5. [2] Thourani VH, Pettitt BJ, Schmidt JA, Cooper WA, Rozycki GS. Validation of surgeon-performed emergency abdominal ultrasonography in pediatric trauma patients. J Pediatr Surg 1998 Feb;33(2):322–8.
Alexander Beckera,b,* Department of Surgery A, Haemek Medical Center, Afula, B. Rappaport School of Medicine, Technion, Haifa, Israel b DeWitt Daughtry Family Department of Surgery, Division of Trauma and Critical Care, Ryder Trauma Center, Miller School of Medicine University, Miami, Florida, USA a
References 1. Becker A, Lin G, McKenney MG, et al. Is the FAST exam reliable in severely injured patients? Injury )2009;(November) [Epub ahead of print]. 2. Soundappan SV, Holland AJ, Cass DT, Lam A. Diagnostic accuracy of surgeonperformed focused abdominal sonography (FAST) in blunt paediatric trauma. Injury 2005;36(August (8)):970–5. 3. Thourani VH, Pettitt BJ, Schmidt JA, et al. Validation of surgeon-performed emergency abdominal ultrasonography in pediatric trauma patients. J Pediatr Surg 1998;3(February (2)):322–8.
Viroj Wiwanitkit* Wiwanitkit House, Bangkhae, Bangkok 10160, Thailand *Tel.: +6624132436 E-mail address: [email protected]
*Correspondence address: Department of Surgery A, Haemek Medical Center, Afula, Israel. Tel.: +972 4 6494327 E-mail address: [email protected] (A. Becker) doi:10.1016/j.injury.2010.05.031
doi:10.1016/j.injury.2010.05.029