FAST accuracy in major pelvic fractures for decision-making of abdominal exploration: Systematic review and meta-analysis
| Autor: | Pongsasit Singhatas, Chunlaches Chaijareenont, Pattawia Choikrua, Napaphat Poprom, Chonlada Krutsri, Tharin Thampongsa, Panuwat Lertsithichai, Preeda Sumpritpradit |
|---|---|
| Rok vydání: | 2020 |
| Předmět: |
medicine.medical_specialty
Exploratory laparotomy medicine.medical_treatment Hemodynamics Trauma Unstable pelvic fracture 03 medical and health sciences 0302 clinical medicine FAST Medicine Focused assessment with sonography for trauma Systematic Review / Meta-analysis business.industry Mortality rate Major pelvic fracture General Medicine medicine.disease Confidence interval 030220 oncology & carcinogenesis Meta-analysis Pelvic fracture Injury Severity Score 030211 gastroenterology & hepatology Surgery Radiology business Abdominal injury |
| Zdroj: | Annals of Medicine and Surgery |
| ISSN: | 2049-0801 |
| Popis: | Background Major pelvic fractures are often associated with intra-abdominal organ injuries. Considering patients’ hemodynamic status, Focused Assessment with Sonography for Trauma (FAST) can facilitate decision-making for abdominal exploration. Non-therapeutic exploratory laparotomy from pelvic fractures should be avoided. Aim of this study is to determine the accuracy of FAST in diagnosing significant intraabdominal hemorrhage that leads to determine whether or not to pursue therapeutic abdominal exploration in patients with major pelvic fractures. Material and methods We systematically reviewed the PubMed and SCOPUS databases from 2009 to 2019 and also using a retrospective review of patients admitted to the Acute Care Surgery service from 2016 to 2019. We performed a meta-analysis by using a random effects model. Results A total 677 patients were analyzed, 28 cases from our hospital. Mean patient age was 40.8 years. Leading mechanism of injury were motor vehicle collision (44.72%), fall from height (13.41%), and motorcycle collision (13.69%). Average injury severity score (ISS) was 32.5 (range: 24.1–50), and overall mortality rate was 11.65%. The pooled sensitivity, specificity, and accuracy of FAST to identify significant intra-abdominal hemorrhage was 79%,90%, and 93%, respectively (95% confidence interval: 89%–94%). Meta-regression revealed no significant correlation between injury severity score and the accuracy of FAST. Conclusion Our meta-analysis revealed that FAST in major pelvic fracture accurately detected significant intra-abdominal hemorrhage. Using FAST in the presence of unstable hemodynamics, we can decide to perform abdominal exploration with the expectation of finding significant intra-abdominal hemorrhage require surgically control. Highlights • Pelvic fractures is limiting the accuracy of FAST because free fluid from a major pelvic fracture could be retroperitoneal hematoma entering the transperitoneal plane into the peritoneal space or intraperitoneal free fluid (hemoperitoneum or uroperitoneum) caused by significant intra-abdominal organ injury. • Using FAST in the presence of unstable hemodynamics, we can decide to perform abdominal exploration with the expectation of finding significant intra-abdominal hemorrhage require surgically control. • Major pelvic fracture with initial FAST negative results, whole-abdomen CT still should be performed to detect occult injury, such as diaphragmatic injuries or hallow viscus organ injuries, which could be missed. |
| Databáze: | OpenAIRE |
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