Role of Focused Assessment with Sonography for Trauma in the Assessment of Blunt Abdominal Trauma – A Review

Abstract

Focused assessment with sonography for trauma (FAST), is the sonographic examination of the abdomen and pelvis for the detection of presence of free fluid in intraperitoneal or pericardial region. Blunt abdominal trauma is one of the most common causes of all injuries. Blunt abdominal trauma is usually not obvious. Hence, often missed, unless, repeatedly looked for. Due to the delay in diagnosis and inadequate treatment of the abdominal injuries, most of the cases are fatal. Knowledge about the management of blunt abdominal trauma has progressively increased. Despite the best techniques and advances in diagnostic and supportive care, morbidity and mortality remain high. This could be due to the interval between trauma and hospitalization, inadequate and lack of appropriate surgical treatment, delay in diagnosis, postoperative complications and associated trauma specially to head, thorax and pelvis. In cases of blunt trauma to the abdomen (BTA), free fluid is generally because of haemorrhage and spilled bowel contents or both; contributing to grave life deceiving conditions and is an important milestone in taking swift action directed towards the need for any critical intervention. FAST is found to be a diagnostic tool initially to detect intra-abdominal fluid in abdominal trauma. With proper training and understanding of the limitations of ultrasound, good results from FAST can be obtained. Patients with a positive FAST are at risk for significant abdominal bleeding that is critical and likely to need laparotomy sooner. The specificity of the FAST is highly dependent on the experience of the person conducting the examination and hence placing the person examining in a major role in determining the need for an emergency intervention. The results of FAST have been both a boon and a curse in deciding the need for further interventions. Situations, where the results have been overlooked, have sometimes proven to be a cause for delay in the management and sometimes have proved have a situational advantage by going for a better radiological investigation like CT (Computed Tomography) scan. The objective of this review article is to study the impact of FAST on blunt trauma abdomen in the management in emergencies. The routine FAST examination doesn’t show any extra benefit in hastening the clinical decision making. While controversy remains, decision of using FAST is left to the individual surgeons’ choice in the emergency department.