title: The utility of FAST for initial abdominal screening of major pelvic fracture patients.
abstract: BACKGROUND
  Focused Assessment with Sonography for Trauma (FAST) is widely used in pelvic fracture patients. We examined the performance of FAST for detecting hemoperitoneum and predicting the need for intra-abdominal hemorrhage control in major pelvic fracture patients.
  
  
  METHODS
  A 5-year retrospective study of major pelvic fracture patients was performed. The presence of hemoperitoneum was confirmed on CT or at laparotomy. The need for hemorrhage control was defined as requiring a surgical or radiological intervention for intra-abdominal bleeding. Hemorrhagic shock (HS) patients had a systolic blood pressure ≤ 90 mmHg or base deficit of ≥ 6 mEq/L on admission.
  
  
  RESULTS
  A total of 120 patients were included, 42 (35 %) of which had any hemoperitoneum and 21 (18 %) had a moderate-large amount. The sensitivity, specificity, and positive and negative predictive values of FAST for any hemoperitoneum were 64, 94, 84, and 83 % and for a moderate-large amount they were 86, 86, 56, and 97 %. In HS patients the indices were 68, 93, 88, and 78 % for any hemoperitoneum and 79, 83, 65, and 91 % for a moderate-large amount. For the need for hemorrhage control, FAST had a positive predictive value of 50 % (16/32) in all and 71 % (12/17) in HS patients. The negative predictive value was 99 % (87/88) in all and 97 % (31/32) in HS patients.
  
  
  CONCLUSIONS
  FAST had a good to excellent diagnostic accuracy, depending on the size of hemoperitoneum. A positive FAST result (even in HS patients) does not reliably predict the need for immediate intra-abdominal hemorrhage control but a negative FAST result renders the need for an intervention highly unlikely.
authors.affiliation: Trauma Unit, Department of Surgery, Academic Medical Center (AMC), University of Amsterdam (UvA), Meibergdreef 9, 1100 DD, Amsterdam, The Netherlands, d.o.verbeek@amc.nl.
authors.forename: Diederik O F
authors.initials: DO
authors.lastname: Verbeek
authors.forename: Ijsbrand A J
authors.initials: IA
authors.lastname: Zijlstra
authors.forename: Christaan
authors.initials: C
authors.lastname: van der Leij
authors.forename: Kornelis J
authors.initials: KJ
authors.lastname: Ponsen
authors.forename: Otto M
authors.initials: OM
authors.lastname: van Delden
authors.forename: J Carel
authors.initials: JC
authors.lastname: Goslings
mesh_terms: D000328:Adult; D001794:Blood Pressure; D005260:Female; D050723:Fractures, Bone / Q000150:complications*; D006465:Hemoperitoneum / Q000000981:diagnostic imaging* / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010384:Pelvic Bones / Q000293:injuries*; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012771:Shock, Hemorrhagic / Q000209:etiology* / Q000503:physiopathology; D014057:Tomography, X-Ray Computed; D014463:Ultrasonography; D055815:Young Adult