Over the past 30 years, trauma surgeons in Europe and Japan have demonstrated the proficient use of ultrasonography in evaluating blunt trauma patients.1–9 During the 1990s, emergency physicians and trauma surgeons in North America have prospectively evaluated the applications of ultrasonography in trauma and have presented results comparable with those of other investigators worldwide.10–18
The focused assessment with sonography for trauma (FAST) examination is a bedside screening tool to aid clinicians in identifying free intrathoracic or intraperitoneal fluid. The underlying premise behind the use of the FAST examination is that clinically significant injuries will be associated with the presence of free fluid accumulation in dependent areas. The FAST examination was originally developed as a limited ultrasound examination, focusing primarily on the detection of free fluid, and was not designed to universally identify all sonographically detectable pathology. Over the last decade many groups have proposed additions or modifications to the standard FAST examination. However, the essence of the FAST examination is identifying findings that can be interpreted by clinicians within a clinical context. As this approach has grown to the extent that some propose integrating ultrasound completely within the advanced trauma life support (ATLS) sequence,19 the challenge for the future is to capitalize on the information point-of-care ultrasound provides, while not delaying critical interventions.20
The rapid and accurate diagnosis of injuries sustained by trauma patients can be difficult, especially when they are associated with other distracting injuries or altered mental status from head injury or drug or alcohol use. In the United States, the three generally accepted diagnostic techniques for evaluating abdominal trauma patients are diagnostic peritoneal lavage (DPL), CT of the abdomen, and ultrasonography. Each of these diagnostic modalities has its own advantages and disadvantages.
DPL remains an excellent screening test for evaluating abdominal trauma. Table 5-1 reviews the advantages and disadvantages of DPL.
Table 5–1. Advantages and Disadvantages of Diagnostic Peritoneal Lavage |Favorite Table|Download (.pdf)
Table 5–1. Advantages and Disadvantages of Diagnostic Peritoneal Lavage
Sensitivity for detecting hemoperitoneum
Availability of equipment
Relative speed with which it can be performed
Low complication rate with an experienced operator
Ability to detect early evidence of bowel perforation
Potential for iatrogenic injury
Misapplication for evaluation of retroperitoneal injuries
Lack of specificity
CT of the abdomen has a greater specificity than DPL, thus making it the initial diagnostic test of choice at all trauma centers. IV contrast material should be given to provide optimal resolution. Table 5-2 reviews the advantages and disadvantages of CT.
Table 5–2. Advantages and Disadvantages of CT |Favorite Table|Download (.pdf)
Table 5–2. Advantages and Disadvantages of CT
Ability to precisely locate intra-abdominal lesions preoperatively
Ability to evaluate the retroperitoneum
Ability to identify injuries that may be managed nonoperatively
Expense of ...