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Inicio Cirugía Española (English Edition) Consequencies of therapeutic decision-making based on FAST results in trauma pat...
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Vol. 99. Issue 6.
Pages 433-439 (June - July 2021)
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Vol. 99. Issue 6.
Pages 433-439 (June - July 2021)
Original article
DOI: 10.1016/j.cireng.2021.05.007
Consequencies of therapeutic decision-making based on FAST results in trauma patients with pelvic fracture
Consecuencias de la toma de decisiones terapéuticas con base en el resultado del FAST en pacientes politraumáticos con fractura pélvica
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Sandra Montmany Vioque
Corresponding author
sandra.montmany@gmail.com

Corresponding author.
, Pere Rebasa Cladera, Andrea Campos Serra, Raquel Gràcia Roman, Alexis Luna Aufroy, Salvador Navarro Soto
Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitari Parc Taulí, Sabadell, Barcelona, Spain
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Tables (3)
Table 1. Demographic data.
Table 2. Results of FAST.
Table 3. Differences in mortality.
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Abstract
Introduction

FAST is essential to decide whether trauma patients need laparotomy, but it has a notable decrease in accuracy in patients with pelvic fracture.

Our objective is to analyze the consequences of therapeutic decision-making based on the FAST results in trauma patients with pelvic fracture.

Methods

Descriptive study that includes trauma patients older than 16 with a pelvic fracture admitted to the critical care area or who died. The FAST result was compared with a true positive or negative value according to the results of laparotomy or abdominal CT. We recorded diagnosis and treatment of each injury and resolution of the case, detailing the cause of death, among all variables.

Results

Over the 13-year period, we included 263 trauma patients with pelvic fracture, with a mean ISS of 31 and mortality of 19%. FAST had a sensitivity of 65.2%, specificity of 69%, false negative rate of 34.8% and false positive rate of 30.9%. Hemodynamically unstable patients died twice as many stable patients (27% vs 14%, P < .05). Patients with positive FAST died more than negative FAST (43% vs 26%); and 4 out of 10 hemodynamically unstable patients who underwent non-therapeutic laparotomy after presenting a false positive FAST died from hypovolemic shock. The mortality rate fell from 60% to 20% when preperitoneal packing was performed before angio-embolization of the pelvis.

Conclusion

FAST has low accuracy in polytraumatized patients with pelvic fracture. Patients with false positive FAST have higher mortality, which can be reduced notably by applying preperitoneal packing.

Keywords:
Trauma patients
Pelvic fracture
FAST
Accuracy
Resumen
Introducción

La exactitud del FAST disminuye notablemente en los pacientes politraumáticos con fractura pélvica.

El objetivo es analizar las consecuencias de tomar decisiones terapéuticas basadas en el resultado del FAST en los pacientes politraumáticos con fractura de pelvis.

Métodos

Estudio descriptivo de pacientes con politraumatismos mayores de 16 años que han ingresado en el área de críticos o que han fallecido previamente, con fractura pélvica. El resultado del FAST ha sido comparado con un valor realmente positivo o negativo según el resultado de la laparotomía o de la tomografía computarizada.

Resultados

En 13 años, se ha incluido a 263 pacientes politraumáticos con fractura pélvica (ISS medio de 31; mortalidad 19%). El FAST tenía una sensibilidad del 65,2%, una especificidad del 69%, una tasa de falsos negativos del 34,8% y una tasa de falsos positivos del 30,9%. Los pacientes hemodinámicamente inestables tenían el doble de mortalidad que los pacientes estables (27% vs. 14%, p < 0,05). Los pacientes con un FAST positivo tenían mayor mortalidad que los pacientes con FAST negativo (43% vs. 26%); 4 de 10 pacientes hemodinámicamente inestables con un FAST falsamente positivo que se sometieron a laparotomía exploradora innecesaria murieron por shock hipovolémico. La mortalidad se redujo del 60 al 20% asociando un packing preperitoneal.

Conclusiones

La reducida eficacia del FAST en pacientes con fractura de pelvis nos obliga a cuestionarnos las consecuencias de la toma de decisiones terapéuticas con base en sus resultados. Los pacientes con FAST falsamente positivo tienen una mortalidad mayor, que se puede reducir aplicando un packing preperitoneal.

Palabras clave:
Paciente politraumático
Fractura de pelvis
FAST
Exactitud

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