Ultrasonographic determination of pubic symphyseal widening in trauma: the FAST-PS study.
BACKGROUND
The focused abdominal sonography in trauma (FAST) examination is a routine component of the initial work-up of trauma patients. However, it does not identify patients with retroperitoneal hemorrhage associated with significant pelvic trauma. A wide pubic symphysis (PS) is indicative of an open book pelvic fracture and a high risk of retroperitoneal bleeding.


OBJECTIVE
We hypothesized that an ultrasound image of the PS as part of the FAST examination (FAST-PS) would be an accurate method to determine if pubic symphysis diastasis was present.


METHODS
This is a comparative study of a diagnostic test on a convenience sample of 23 trauma patients at a Level 1 Trauma Center. The PS was measured sonographically in the Emergency Department (ED) and post-mortem (PM) at the State Medical Examiner. The ultrasound (US) measurements were then compared with PS width on anterior-posterior pelvis radiograph.


RESULTS
Twenty-three trauma patients were evaluated with both plain radiographs and US (11 PM, 12 ED). Four patients had radiographic PS widening (3 PM, 1 ED) and 19 patients had radiographically normal PS width; all were correctly identified with US. US measurements were compared with plain X-ray study by Bland-Altman plot. With one exception, US measurements were within 2 standard deviations of the radiographic measurements and, therefore, have excellent agreement. The only exception was a patient with pubic symphysis wider than the US probe.


CONCLUSIONS
Bedside ultrasound examination may be able to identify pubic symphysis widening in trauma patients. This potentially could lead to faster application of a pelvic binder and tamponade of bleeding.
Bauman
Michael
M
Department of Emergency Medicine, University of New Mexico Hospital, Albuquerque, New Mexico, USA.
Marinaro
Jonathan
J
Tawil
Isaac
I
Crandall
Cameron
C
Rosenbaum
Lizabeth
L
Paul
Ian
I
D000328:Adult; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D008297:Male; D011631:Pubic Symphysis / Q000000981:diagnostic imaging* / Q000293:injuries*; D046548:Pubic Symphysis Diastasis / Q000000981:diagnostic imaging*; D011859:Radiography; D012680:Sensitivity and Specificity; D014463:Ultrasonography