The FAST Exam Can Reliably Identify Patients with Significant Intraabdominal Hemorrhage in Life Threatening Pelvic Fractures.

BACKGROUND: The Focused Abdominal Sonography for Trauma (FAST) exam has been reported to be unreliable in pelvic fracture patients. Additionally, given the advent of new therapeutic interventions, such as Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA), rapid identification of intraabdominal hemorrhage compared to zone III hemorrhage may guide different therapeutic strategies. We hypothesized that FAST is reliable for detecting clinically significant intraabdominal hemorrhage in the face of complex pelvic fractures.

METHODS: Our pelvic fracture database of all hemodynamically unstable patients requiring intervention from 1/1/05 to 7/1/15 was reviewed. FAST exam was compared to operative and CT scan findings. Confirmatory evaluation for FAST(-) patients was considered positive if therapeutic intervention was required.

RESULTS: During the study period, 81 patients in refractory shock with FAST imaging in our ED underwent pelvic packing. Mean age was 45 ± 2 years and ISS was 50 ± 1.5. The FAST exam was negative in 53 patients; 52 patients did not require operative intervention for abdominal bleeding while 1 patient required splenectomy. FAST exam was positive in 28 patients; 26 had findings confirmed by CT or laparotomy while 2 patients did not have intraabdominal hemorrhage on further evaluation. The sensitivity and specificity for FAST in this population was 96% and 96%; PPV was 93% and NPV was 98%. The false negative and positive rates for FAST were 2% and 7%.

CONCLUSIONS: FAST reliably identifies clinically significant hemoperitoneum in life-threatening, pelvic fracture related hemorrhage. The incidence of a false negative FAST in this unstable pelvic fracture population was 2%. FAST results may be used when determining the role of REBOA in these multisystem trauma patients and requires further study. REBOA placement should be considered in hemodynamically unstable pelvic fracture patients who are FAST(-), while laparotomy should be used in FAST(+) patients.

LEVEL OF EVIDENCE: Level III, case control series for therapeutic/prognostic management.