Limitations of Focused Assessment with Sonography for Trauma in Pelvic Trauma: A Retrospective Review of False-Positive Results and Non-Therapeutic Laparotomies.

INTRODUCTION

Focused assessment with sonography for trauma (FAST) is an important adjunct for quickly detecting intra-abdominal hemorrhage. The study was aimed to identify the incidence of non-therapeutic laparotomies with positive FAST result and pelvic fracture.

MATERIALS AND

METHODS

A retrospective review of prospectively maintained data was conducted to identify cases of pelvic fracture with positive FAST results. Cases with non-therapeutic laparotomies were analyzed for the cause of false FAST positive result. The data were collected and analyzed for the mechanism of injury, associated injuries and injury severity.

RESULTS

Out of 195 cases of pelvic fracture with positive FAST result, only 5 cases (2.5%) had non-therapeutic laparotomies. Most were operated without a computed tomography scan due to hemodynamic instability. One patient was operated in view of peritonitis. Most common type of the injury requiring operative intervention was a vertical shear fracture. One patient was managed with an immediate external fixator, while three underwent a definitive pelvis fixation at a later date. One patient was managed conservatively.

CONCLUSION

FAST has a high sensitivity for intra-abdominal bleeding. However, retroperitoneal hematoma in pelvic fractures can lead to false-positive FAST results. Therefore, we advocate for a comprehensive approach encompassing clinical judgment, additional imaging for stable patients, the engagement of a multidisciplinary team, and surgical expertise to ensure optimal patient care and outcomes.