Choon, Lee Kee
(2020)
Usage Of Focused Assessment with Sonography in Trauma (Fast) Scan in Blunt Intraabdominal Trauma.
Masters thesis, Universiti Sains Malaysia.
Abstract
Background
Blunt intra-abdominal trauma (BAT) encompasses a major portion of trauma cases in the
emergency department (ED). It poses a difficulty in diagnosis due to its low sensitivity and
specificity of history and physical examination. Morison pouch is typically considered the most
common area of free fluid (FF) in BAT visualized on the focused assessment with sonography
in trauma (FAST) scan. However, no studies to date have investigated the correlation of the
abdominal quadrant for positive FF with the type of abdominal trauma. This study aims to
determine the most common quadrant and subquadrants for detecting FF and their association
with the type of injury in BAT patients.
Methods
This multicenter study evaluated 86 BAT patients who presented to the ED. The FAST scan
was performed per trauma life support protocol, and video clips were extracted for patients
with positive FAST findings confirmed by abdominal computed tomography (CT) or
exploratory laparotomy. The most common quadrant and subquadrant positive for FF were
then determined. Positive quadrants and their association with type of injury were also
analyzed. Areas studied were the right upper quadrant (RUQ), left upper quadrant (LUQ), and
suprapubic area (SP). Subquadrant areas were RUQ 1–hepato-diaphragmatic; RUQ 2–Morison
pouch; RUQ 3–caudal liver edge and superior para-colic gutter; LUQ 1–splenicdiaphragmatic;
LUQ 2–spleno-renal; LUQ 3–around the inferior pole of kidney; SP 1–bilateral to bladder; SP 2–posterior to bladder; and SP 3–posterior to uterus.
Results
The most frequent region with positive FF results was the RUQ, seen in 82 (95.3%) patients.
In subquadrant analysis, RUQ 3 was the most common region (78 patients, 90.75%), followed
by RUQ 2 (73 patients, 84.9%) and LUQ 2 (51 patients, 59.3%). A significant association was
observed between the LUQ region positive for FF and the presence of splenic injury (p =
0.006).
Conclusion
In patients with BAI, the RUQ is the most frequent quadrant and RUQ 3 is the most frequent
subquadrant positive FF. A positive LUQ free fluid suggests the presence of splenic injury in
BAT.
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