Combination of Focused Assessment With Sonography for Trauma (FAST) Scan and Detection of Hematuria to Exclude Intra-abdominal Injuries Following Blunt Abdominal Trauma

Background Blunt abdominal trauma (BAT) is the most common pattern of abdominal traumas. It may be associated with intra-abdominal injuries (IAIs). Exploratory laparotomies are only needed in a minority of patients after BAT. Methodology All BAT patients who presented to the El Demerdash Hospital of Ain Shams University, Cairo, Egypt during the study period were traced. Parameters including demographic data, focused assessment with sonography for trauma (FAST) scan, CT scan results, and hematuria were collected. The cohort was divided according to the CT scan results into two groups: patients with IAIs and patients without IAIs. Results Males represented 78.2% of the patients, and the mean age of the recruited patients was 32.1 ± 18 years. Road traffic accidents represented the main cause of trauma (58%). Patients with IAIs detected by CT scan represented 1.62%, and hematuria was detected in 88.9% of them. The specificity of FAST was 97.1%, and that of hematuria was 84.1%, and for the combination of both tests, the specificity was 99.3%. Conclusion IAIs after BAT can usually be excluded if both FAST and hematuria are negative, provided that the patient is stable.

[1]  M.E. Awad-Allah,et al.  Pattern of intra-peritoneal intra-abdominal injuries in polytrauma patients admitted to general surgery department at El-Demerdash Hospital , 2021, The Quarterly journal of medicine.

[2]  Preeda Sumritpradit,et al.  Can we omit surgery in patients with isolated free fluid following blunt abdominal injury? A systematic review and meta-analysis , 2021 .

[3]  D. Zaki,et al.  Clinical and Laboratory Evaluation of Blunt Trauma Patients for the Early Diagnosis of Intra-Abdominal Injuries , 2021, Ain Shams Journal of Forensic Medicine and Clinical Toxicology.

[4]  J. Wood,et al.  Utility of screening urinalysis to detect abdominal injuries in suspected victims of child physical abuse. , 2020, Child abuse & neglect.

[5]  B. Friemert,et al.  Diagnostic options for blunt abdominal trauma , 2020, European Journal of Trauma and Emergency Surgery.

[6]  J. Hirshon,et al.  Non-operative management of blunt abdominal solid organ trauma in adult patients , 2020, African journal of emergency medicine : Revue africaine de la medecine d'urgence.

[7]  Majid Shojaee,et al.  Efficacy of new scoring system for diagnosis of abdominal injury after blunt abdominal trauma in patients referred to emergency department , 2020, Chinese journal of traumatology = Zhonghua chuang shang za zhi.

[8]  A. Ghanghoria,et al.  To study the relationship between mode of injury and clinical presentation in blunt abdominal trauma at MGM medical college & M.Y. hospital, Indore , 2019, International Journal of Surgery Science.

[9]  E. Fox,et al.  The focused assessment with sonography in trauma (FAST) in hypotensive injured patients frequently fails to identify the need for laparotomy: a multi-institutional pragmatic study , 2019, Trauma Surgery & Acute Care Open.

[10]  B. Schmitz-Dräger,et al.  The Investigation of Hematuria. , 2018, Deutsches Arzteblatt international.

[11]  A. Qadri,et al.  Epidemiology and injury pattern in blunt trauma abdomen in pediatric population: a two-year experience in a tertiary care institute of Kashmir, India , 2018, International Surgery Journal.

[12]  F. Moideen,et al.  ADVANCED JOURNAL OF EMERGENCY MEDICINE. 2018; 2(2): e15 , 2019 .

[13]  F. Moustafa,et al.  Assessment of urinary dipstick in patients admitted to an ED for blunt abdominal trauma , 2017, The American journal of emergency medicine.

[14]  M. El Moumni,et al.  Should we perform a FAST exam in haemodynamically stable patients presenting after blunt abdominal injury: a retrospective cohort study , 2017, Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine.

[15]  R. Peralta,et al.  Frequency, causes and pattern of abdominal trauma: A 4-year descriptive analysis , 2015, Journal of emergencies, trauma, and shock.

[16]  A. Cuschieri,et al.  Essential Surgical Practice: Higher Surgical Training in General Surgery , 2015 .

[17]  James W. Davis,et al.  Isolated free fluid on abdominal computed tomography in blunt trauma: watch and wait or operate? , 2014, Journal of the American College of Surgeons.

[18]  H. Mikami,et al.  Japanese guidelines of the management of hematuria 2013 , 2014, Clinical and Experimental Nephrology.

[19]  T. Wollin,et al.  Canadian guidelines for the management of asymptomatic microscopic hematuria in adults. , 2013, Canadian Urological Association journal = Journal de l'Association des urologues du Canada.

[20]  T. Deberardino,et al.  Evaluation of blunt abdominal trauma. , 2013, Clinics in sports medicine.

[21]  J. Haukoos,et al.  Blunt Abdominal Trauma Patients Are at Very Low Risk for Intra-Abdominal Injury after Emergency Department Observation , 2011, The western journal of emergency medicine.

[22]  Morten Hestnes,et al.  Ultrasound performed by radiologists-confirming the truth about FAST in trauma. , 2009, The Journal of trauma.

[23]  S. Fakhry,et al.  Physical examination is a poor screening test for abdominal-pelvic injury in adult blunt trauma patients. , 2009, The Journal of surgical research.

[24]  S. L. Murphy,et al.  Deaths: final data for 2004. , 2007, National vital statistics reports : from the Centers for Disease Control and Prevention, National Center for Health Statistics, National Vital Statistics System.

[25]  B. Enderson,et al.  Prospective comparison of microscopic and gross hematuria as predictors of bladder injury in blunt trauma. , 2007, Urology.

[26]  D. Neal,et al.  Diagnostic tests and algorithms used in the investigation of haematuria: systematic reviews and economic evaluation. , 2006, Health technology assessment.

[27]  B. Jarrell.  SCHWARTZ??S PRINCIPLES OF SURGERY, 8TH EDITION , 2005 .

[28]  大城 理,et al.  3D Echocardiography , 1998 .

[29]  J. Richards,et al.  Computed tomography and blunt abdominal injury: patient selection based on examination, haematocrit and haematuria. , 1997, Injury.

[30]  M. Knudson,et al.  Hematuria as a predictor of abdominal injury after blunt trauma. , 1992, American journal of surgery.

[31]  M. Eichelberger,et al.  Hematuria. A marker of abdominal injury in children after blunt trauma. , 1988, Annals of surgery.

[32]  E. Ruiz,et al.  Are urine dipsticks reliable indicators of hematuria in blunt trauma patients , 1984 .

[33]  Bryan C. Knepper,et al.  A negative urinalysis is associated with a low likelihood of intra-abdominal injury after blunt abdominal trauma. , 2017, American journal of surgery.

[34]  S. Bhoi,et al.  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 , 2013, Journal of emergencies, trauma, and shock.

[35]  Nihon Jinzō Gakkai.  [Japanese guidelines of the management of hematuria]. , 2013, Nihon Jinzo Gakkai shi.

[36]  A. Zisman,et al.  Use of adult criteria for slice imaging may limit unnecessary radiation exposure in children presenting with hematuria and blunt abdominal trauma. , 2011, Urology.