title: Scanning and War: Utility of FAST and CT in the Assessment of Battlefield Abdominal Trauma.
abstract: OBJECTIVE
  To determine utilization and accuracy of focused assessment with sonography for trauma (FAST) and computed tomography (CT) in a mature military trauma system to inform service provision for future conflicts.
  
  
  BACKGROUND
  FAST and CT scans undertaken by attending radiologists contribute to surgical decision making for battlefield casualties at the Joint Force, Role 3 Medical Treatment Facility at Camp Bastion (R3), Afghanistan.
  
  
  METHODS
  Registry data for abdominally injured casualties treated at R3 from July to November 2012 were matched to radiological and surgical records to determine diagnostic accuracy for FAST and CT and their influence on casualty management.
  
  
  RESULTS
  A total of 468 casualties met inclusion criteria, of whom 85.0% underwent FAST and 86.1% abdominal CT; 159 (34.0%) had abdominal injuries. For detection of intra-abdominal injury, FAST sensitivity (Sn) was 0.56, specificity (Sp) 0.98, positive predictive value (PPV) 0.87, negative predictive value (NPV) 0.90, and accuracy (Acc) 0.89. For CT, Sn was 0.99, Sp 0.99, PPV 0.96, NPV 1.00, and Acc 0.99. Forty-six solid organ injuries were identified in 38 patients by CT; 17 were managed nonoperatively. A further 61 patients avoided laparotomy after CT confirmed extra-abdominal wounds only. The negative laparotomy rate was 3.9%.
  
  
  CONCLUSIONS
  FAST and CT contribute to triage, guide surgical management, and reduce nontherapeutic laparotomy. When imaging is available, these data challenge current doctrine about inadvisability of nonoperative management of abdominal injury after combat trauma.
authors.affiliation: *Royal Centre for Defence Medicine, Queen Elizabeth Hospital, Edgbaston, Birmingham, UK; †202 (Midlands) Field Hospital, Roger Nutbeem House, Kings Heath, Birmingham, West Midlands, UK, and ‡NIHR Surgical Reconstruction and Microbiology Research Centre, Queen Elizabeth Hospital, Edgbaston, Birmingham, UK.
authors.forename: Iain M
authors.initials: IM
authors.lastname: Smith
authors.forename: David N
authors.initials: DN
authors.lastname: Naumann
authors.forename: Max E R
authors.initials: ME
authors.lastname: Marsden
authors.forename: Mark
authors.initials: M
authors.lastname: Ballard
authors.forename: Douglas M
authors.initials: DM
authors.lastname: Bowley
mesh_terms: D000007:Abdominal Injuries / Q000000981:diagnostic imaging* / Q000628:therapy; D000328:Adult; D000346:Afghanistan; D005260:Female; D006801:Humans; D007813:Laparotomy; D008297:Male; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed; D014218:Triage; D014463:Ultrasonography; D006113:United Kingdom; D014857:Warfare; D055815:Young Adult