@article{4144943d72a94e5591f138cc7fed13f4,
title = "The focused assessment with sonography in trauma (FAST) in hypotensive injured patients frequently fails to identify the need for laparotomy: A multiinstitutional pragmatic study",
abstract = "Background The ability of focused assessment with sonography for trauma (FAST) to detect clinically significant hemorrhage in hypotensive injured patients remains unclear. We sought to describe the sensitivity and specificity of FAST using findings at laparotomy as the confirmatory test. Methods Patients from the Prospective Observational Multicenter Major Trauma Transfusion (PROMMTT) study that had a systolic blood pressure < 90mm Hg and underwent FAST were analysed. Results were compared with findings at laparotomy. A therapeutic laparotomy (T-LAP) was defined as an abdominal operation within 6 hours in which a definitive procedure was performed. The sensitivity and specificity of FAST were calculated. Results The cohort included 317 patients that underwent FAST (108 positive, 209 negative). T-LAP was performed in 69% (n=75) of FAST(+) patients and 22% (n=48) of FAST(-) patients. FAST had a sensitivity of 62% and specificity of 83%. Conclusions In our multicenter cohort, 22% of FAST(-) patients underwent T-LAP within 6 hours of admission. In hypotensive patients with a negative FAST, clinicians should still maintain a high index of suspicion for significant abdominal hemorrhage. Level of evidence Level IV.",
author = "{PROMMTT Study Group} and Rowell, {Susan E.} and Barbosa, {Ronald R.} and Holcomb, {John B.} and Fox, {Erin E.} and Barton, {Cassie A.} and Schreiber, {Martin A.} and Rahbar, {Mohammad H.} and {Del Junco}, {Deborah J.} and Wade, {Charles E.} and Jiajie Zhang and Nena Matijevic and Yu Bai and Weiwei Wang and Jeanette Podbielski and Duran, {Sarah J.} and Ruby Benjamin-Garner and Reynolds, {Robert J.} and White, {Christopher E.} and Franzen, {Kimberly L.} and Coates, {Elsa C.} and Brasel, {Karen J.} and Pamela Walsh and Underwood, {Samantha J.} and Jodie Curren and Cohen, {Mitchell J.} and {Margaret Knudson}, M. and Mary Nelson and Call, {Mariah S.} and Peter Muskat and Johannigman, {Jay A.} and Robinson, {Bryce R.H.} and Richard Branson and Dina Gomaa and Cendi Dahl and Alarcon, {Louis H.} and Peitzman, {Andrew B.} and Stull, {Stacy D.} and Mitch Kampmeyer and Early, {Barbara J.} and Shnol, {Helen L.} and Zolin, {Samuel J.} and Sears, {Sarah B.} and Cotton, {Bryan A.} and Marily Elopre and Hatch, {Quinton M.} and Michelle Scerbo and Zerremi Caga-Anan and Myers, {John G.} and Stewart, {Ronald M.} and Sambucini, {Rick L.}",
note = "Funding Information: Funding This project was funded by the US Army Medical Research and Material Command subcontract W81XWH-08-C-0712. Infrastructure for the Data Coordinating Center was supported by CTSA funds from NIH grant UL1 RR024148. Funding Information: Competing interests JBH reported serving on the board for Tenaxis, the Regional Advisory Council for Trauma and the National Trauma Institute; providing expert testimony for the Department of Justice; grants funded by the Haemonetics Corporation and KCI USA and consultant fees from the Winkenwerder Company. No other disclosures were reported. Patient consent Not required. ethics approval Approval was obtained from the Institutional Review Boards at each center and from the US Army Human Research Protections Office. Provenance and peer review Not commissioned; externally peer reviewed. open access This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0 Publisher Copyright: {\textcopyright} Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.",
year = "2019",
doi = "10.1136/tsaco-2018-000207",
language = "English (US)",
volume = "4",
journal = "Trauma Surgery and Acute Care Open",
issn = "2397-5776",
publisher = "BMJ Publishing Group",
number = "1",
}