Frequency of positive patients to eco-fast and later CT in major abdominal trauma: our experience Poster No.: C-0155 Congress: ECR 2012 Type: Scientific Exhibit Authors: G. Posillico Keywords: Abdomen, Trauma, Spleen, CT, Ultrasound, Diagnostic procedure, Computer Applications-3D, Haemorrhage DOI: 10.1594/ecr2012/C-0155 Any information contained in this pdf file is automatically generated from digital material submitted to EPOS by third parties in the form of scientific presentations. References to any names, marks, products, or services of third parties or hypertext links to thirdparty sites or information are provided solely as a convenience to you and do not in any way constitute or imply ECR's endorsement, sponsorship or recommendation of the third party, information, product or service. ECR is not responsible for the content of these pages and does not make any representations regarding the content or accuracy of material in this file. As per copyright regulations, any unauthorised use of the material or parts thereof as well as commercial reproduction or multiple distribution by any traditional or electronically based reproduction/publication method ist strictly prohibited. You agree to defend, indemnify, and hold ECR harmless from and against any and all claims, damages, costs, and expenses, including attorneys' fees, arising from or related to your use of these pages. Please note: Links to movies, ppt slideshows and any other multimedia files are not available in the pdf version of presentations. www.myesr.org Page 1 of 18
Purpose To evaluate the frequency of patients which are positive for eco-fast and following multislice CT in case of significant non-penetrating abdominal traumas received into Emergency department Caserta's A.O.R.N. Focused Assessment with Sonography for Trauma (commonly abbreviated as FAST) is a rapid bedside ultrasound examination performed by surgeons and emergency physicians as a screening test for blood around the heart (pericardial tamponade) or abdominal organs (hemoperitoneum) after trauma. The four areas that are examined for free fluid are the perihepatic space (also called Morison's pouch or the hepatorenal recess), perisplenic space, pericardium, and the pelvis; with this technique it is possible to identify the presence of intraperitoneal or pericardial free fluid. In the context of traumatic injury, this fluid will usually be due to bleeding. Page 2 of 18
Methods and Materials Here we show the frequency of patients with significant non-penetrating abdominal traumas received in our PS and then into our radiology unit during the last four years, the diagnostic procedure, the positive result for eco-fast (picture 1) performed in case of emergency in room code red in emergency department, and the following CT multislice control if requested from emergency surgery. We evaluate patients of any age, but the majority are older than sixteen years. Page 3 of 18
Images for this section: Fig. 1: Ultrasound Page 4 of 18
Results During the last four years about 20000 cases of significant non-penetrating abdominal traumas have been received into our hospital; the 80% of them were positive for Ecofast performed in room code red in emergency department by the radiologist on duty, considering positive as only the cases with free fluid in abdomen The 70% of these was requested for the CT multislice control from emergency surgery, if the patient was hemodynamicly stable. This control confirmed the positive result in almost totality of cases, detecting the traumatic lesion. In most cases the patients studied in ultrasound were in conditions of great discomfort and often agitated, and in some cases not even made by the intensivist hemodynamically stable. The majority of cases was hepatic (picture 2, 3, 4) and splenic trauma (picture 5, 6, 7, 8), at confirmed at following CT. The following laparotomy confirmed the diagnosis of ultrasound and CT. Page 5 of 18
Images for this section: Fig. 2: CT-scan Page 6 of 18
Fig. 3: CT-scan Page 7 of 18
Fig. 4: CT-scan Page 8 of 18
Fig. 5: CT-scan Page 9 of 18
Fig. 6: CT-scan Page 10 of 18
Fig. 7: CT-scan Page 11 of 18
Fig. 8: CT-scan Page 12 of 18
Conclusion The eco-fast is the procedure adopted first in case of non-penetrating abdominal traumas as it has already been demonstrated. It presents a high frequency (sensibility, specificity and accuracy) of positive result confirmed by CT multislice control (picture 9, 10, 11). Sensibility near 78%, specificity near 99 %, accuracy near 95%, as our statistical study. However, it should be performed by radiologists experienced in echographic procedure in case of emergency, because of the gravity of situation and unfavorable working conditions. Page 13 of 18
Images for this section: Fig. 9: Reconscruction 3D Page 14 of 18
Fig. 10: CT-scan Page 15 of 18
Fig. 11: CT-scan Page 16 of 18
References 1."Evaluation of focused assessment with sonography in trauma (FAST) by UK emergency physicians" Brenchley et al.- Emerg Med J. 2006 Jun; 23 (6):446-8; 2."Emergency physicianuse of ultrasonography in blunt abdominal trauma" Ingeman et al.- Acad Emerg Med. 1996 Oct; 3 (10):932-7; 3. "Free abdominal fluid on ultrasound in unstable pelvic ring fracture: is laparotomy always necessary?" Ruchholtz et al.-j Trauma.2004 Aug;57 (2):278-85; 4."Ultrasound in trauma" Rippey et al.-best Pract Res Clin Anaesthesiol. 2009 Sep;23 (3) :343-62; 5."Focused abdominal sonography for trauma in the emergency department for blunt abdominal trauma" Tsui et al.-int J Emerg Med. 2008 Sep;1(3); 183-7. Epub 2008 Sep 26. Page 17 of 18
Personal Information G.POSILLICO, M.IODICE, L.MANFREDONIA, G.MOGGIO, BELFIORE*, N.SERAO**, A. FERRONE, G.BELFIORE E.TUFANO, M.P. DIPARTIMENTO DEI SERVIZI INTEGRATI E DIAGNOSTCI AZIENDA OSPEDALIERA DI RILEVANZA NAZIONALE "S'ANNA E SAN SEBASTIANO" DI CASERTA *DIPARTIMENTO DI INTERNISTICA CLINICA E SPERIMENTALE "F.MAGRASSI"U.O.C. DI RADIODIAGNOSTICA-SECONDA UNIVERSITà DEGLI STUDI DI NAPOLI ** DIPARTIMENTO ASSISTENZIALE DI DIAGNOSTICA PER IMMAGINI E RADIOTERAPIA AZIENDA OSPEDALIERA UNIVERSITARIA "FEDERICO II" DI NAPOLI Page 18 of 18