Hemodynamically stable patient after blunt abdominal trauma: FAST or CT?

[Cantaloupe5]

UWorld says FAST, Amboss says CT... which one is it?

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[NecrotizingFasciitis]

I've been learning by UWorld, but in my mind it would make sense to do a cheaper, quicker test (FAST) before a CT. You'd also prevent exposing a patient to radiation if the FAST is normal.

 

[Cantaloupe5]

I've been learning by UWorld, but in my mind it would make sense to do a cheaper, quicker test (FAST) before a CT. You'd also prevent exposing a patient to radiation if the FAST is normal.

But if someone had abdominal pain following blunt abdominal trauma, are you really not going to get a CT even if FAST is normal? It seems silly to do a less sensitive test and follow it up with another test you're going to have to do anyway.

 

[NecrotizingFasciitis]

This article says Amboss is right (from 2006 though): Focussed Assessment Sonograph Trauma (FAST) and CT scan in blunt abdominal trauma: surgeon's perspective

And ya maybe FAST is just help with deciding whether or not to send the patient to the OR immediately, but if they are hemodynamically stable you can skip FAST & jump to CT (according to Amboss.)

But ya I'm looking at the exact image from UWorld that runs down the evaluation of blunt abdominal trauma in a hemodynamically stable patient right now. It says:

alert/normal mental status --> if no --> serial abdominal exams +/- CT scan
--> if yes --> FAST Exam

FAST --> (+) --> CT abdomen
--> (-) --> serial abdominal exams +/- CT scan

Not sure what to think now.

 

[Cantaloupe5]

This article says Amboss is right (from 2006 though): Focussed Assessment Sonograph Trauma (FAST) and CT scan in blunt abdominal trauma: surgeon's perspective

And ya maybe FAST is just help with deciding whether or not to send the patient to the OR immediately, but if they are hemodynamically stable you can skip FAST & jump to CT (according to Amboss.)

But ya I'm looking at the exact image from UWorld that runs down the evaluation of blunt abdominal trauma in a hemodynamically stable patient right now. It says:

alert/normal mental status --> if no --> serial abdominal exams +/- CT scan
--> if yes --> FAST Exam

FAST --> (+) --> CT abdomen
--> (-) --> serial abdominal exams +/- CT scan

Not sure what to think now.

Yeah I've seen that chart too and the mental status distinction doesn't make sense to me. Why would an altered mental status lead to a more conservative plan (serial abdominal exams)?

Based on their algorithm for positive/negative FAST though, I think CT is not always indicated with a negative FAST and and further imaging probably depends on the rest of the clinical picture (e.g. mild pain, benign exam --> serial abdominal exams; severe pain and tenderness --> CT). This is the logic I'm going with right now.

 

[darksoul11111]

UWorld says FAST, Amboss says CT... which one is it?

Get a CT. FAST cannot assess for RP hematoma, which can be a presentation of a Aortic Rupture. The goal of the FAST exam is to confirm the clinical decision of a emergent exploratory laparotomy.

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