Predictive Factors for a FAST-Positive and a Therapeutic Laparotomy in Blunt Abdominal Injuries at the Emergency Room
Prasit Wuthisuthimethawee MD*
Affiliation : * Department of Emergency Medicine, Songklanagarind Hospital, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
Objective : Identify the various factors that predict a Focused Assessment with Sonography for Trauma (FAST) positive result
and a subsequent therapeutic laparotomy.
Material and Method: The medical records of all patients, aged greater than fifteen-years-old, with blunt abdominal injuries
that underwent a FAST examination in an emergency room at a university level I trauma center over a one-year period were
reviewed retrospectively. Patient data (demographic, vital signs and revised trauma score) was analyzed to identify the
factors that correlated with a FAST-positive result and the need to perform a therapeutic laparotomy.
Results : Four hundred sixty five patients were eligible, of which twenty-eight patients had a FAST-positive result, and
thirty-one patients underwent a therapeutic laparotomy. In multivariate analysis, the significant factors correlating with a
FAST-positive result were an initial O2 saturation of 95% or less (OR = 4.0, 95% CI 1.4-11.5) and an abnormal abdominal
examination (OR = 9.8, 95% CI 3.1-31.1). The factors correlating with a therapeutic laparotomy were a time of injury of one
hour or less (OR = 11.2, 95% CI 1.1-116.8) and a FAST-positive result (OR = 11.1, 95% CI 1.1-113.6).
Conclusion : Patients with blunt abdominal injuries who present with decreased oxygen saturation and an abnormal abdominal
examination have a high probability of FAST-positive result. Patients with the time of injury of less than one hour before
reaching the emergency room, and a FAST-positive are important predictors of the need for therapeutic laparotomy.
Keywords : FAST, Hemoperitoneum, Therapeutic laparotomy
