ABDOMINAL INJURIES WITHOUT HEMOPERITONEUM - A POTENTIAL LIMITATION OFFOCUSED ABDOMINAL SONOGRAPHY FOR TRAUMA [FAST]

Background: Focused abdominal sonography for trauma (FAST) relies on h emoperitoneum to identify patients with injury, Blunt trauma victims ( BTVs) with abdominal injury, but without hemoperitoneum, on admission are at risk for missed injury. Methods: Clinical, radiologic, and FAST data were collected prospectively on BTVs over a 12-month period, All patients with FAST-negative for hemoperitoneum were further analyzed, Examination findings and associated injuries were evaluated for assoc iation with abdominal lesions. Results: Of 772 BTVs undergoing FAST, 5 2 (7%) had abdominal injury, Fifteen of 52 (29%) had no hemoperitoneum by admission computed tomographic scan, and all had FAST interpreted as negative, Four patients with splenic injury underwent laparotomy, S ix other patients with splenic injury and five patients with hepatic i njury were managed nonoperatively, Clinical risk factors significantly associated with abdominal injury in BTVs without hemoperitoneum inclu de: abrasion, contusion, pain, or tenderness in the lower chest or upp er abdomen; pulmonary contusion; lower rib fractures; hemo- or pneumot horax; hematuria; pelvic fracture; and thoracolumbar spine fracture. C onclusions: Up to 29% of abdominal injuries may be missed if BTVs are evaluated with admission FAST as the sole diagnostic tool, Considerati on of examination findings and associated injuries should reduce the r isk of missed abdominal injury in BTVs with negative FAST results.