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Nicole A. Stassen, MD; James K. Lukan, MD; Eddy H. Carrillo, MD; David A. Spain, MD; J. David Richardson, MD

Arch Surg. 2002;137:718-723.

Hypothesis  Focused abdominal sonography for trauma (FAST) is an unreliable method for assessing intra-abdominal injury in patients with seat belt marks.

Design  Retrospective review of trauma patients with intestinal injury and seat belt marks during a 3-year period. Records were reviewed for patient demographics, FAST results, computed tomographic (CT) scan results, and operative findings. The CT scan results were considered positive if bowel wall thickening, extraluminal air, or free fluid without solid organ injury were present.

Setting  University hospital designated as a level I trauma center.

Patients  Twenty-three patients who required operation for intestinal or mesenteric injury and who had an abdominal seat belt mark.

Main Outcome Measure  Sensitivity of FAST in these patients.

Results  All patients were evaluated using both FAST and CT scan of the abdomen and pelvis. Eighteen patients (78%) had either negative or equivocal FAST results when significant intestinal injury was present. All 23 patients had CT scan findings suggestive of bowel or mesenteric injury. Moderate-to-large free intraperitoneal fluid without solid organ injury was the most common finding (n = 21, 91%). Operative findings included small-bowel perforation (n = 18, 78%), colonic perforation (n = 7, 30%), bowel deserosalization (n = 8, 35%), and isolated mesenteric injury (n = 5, 22%). Sixteen patients (70%) had multiple intra-abdominal injuries. All patients were taken directly from the emergency department to the operating room. Seventeen percent of operative explorations (4/23) were nontherapeutic (no repairs required).

Conclusion  This study confirms that FAST cannot reliably exclude intestinal injury in patients with seat belt marks.

From the Departments of Surgery, University of Louisville and University of Louisville Hospitals, Louisville, Ky (Drs Stassen, Lukan, and Richardson), Memorial Regional Hospital, Hollywood, Fla (Dr Carrillo), and Stanford University, Stanford, Calif (Dr Spain).

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