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Sat, 29 Mar 2003 17:08:43 EST

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In a message dated 3/29/2003 4:10:04 PM Eastern Standard Time, 
karim@trauma.org writes:

> FAST does not help decision making in haemodynamically stable blunt 
> abdominal trauma.
>  FAST positive -> CT.  FAST negative -> CT.
>  Good practice though.
> 

Maybe this is what you practice, Karim, but you are wrong to generalize so on 
behalf of everyone else. You need to qualify assertions like that above as 
"in our hands...." In fact we use the FAST in many settings in stable 
patients in whom there is some evidence of abdominal trauma--i.e. complaint 
of abdominal pain, unconscious with appropriate mechanism, history of 
hypotension at the scene but stable now, etc.  If it is negative we go no 
further except serial exam--if positive, as said, we will CT.  
     The FAST is most useful in this way as the initial, and if negative, the 
only screen in stable patients.  If negative, we do continue to observe 
only--a neg FAST is not sufficient to discharge a patient.  If the patient 
has no other reason for hospitalization, however, than the possibility of 
abdominal organ injury, we then will CT--because if the CT is negative, that 
IS sufficient for then discharging the patient (Livingston et al, J of Trauma 
Feb 1998).  Many do use the abd CT as this initial screen, like you, which 
also works--just more expensive and more radiation, and more charge to the 
patient.  Using FAST in this way works JUST as well, with a great reduction 
in the need for CT--as our study in J of T 1997 (Imami et al, Throughput 
Analysis...) showed comparing the six months before and six months after our 
adoption of FAST, with no change in patient outcome, and as many other 
centers have also demonstrated since--and, of course, no study has yet 
refuted.
ERF

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<HTML><FONT FACE=3Darial,helvetica><FONT  SIZE=3D2 FAMILY=3D"SANSSERIF" FACE=
=3D"Arial" LANG=3D"0">In a message dated 3/29/2003 4:10:04 PM Eastern Standa=
rd Time, karim@trauma.org writes:<BR>
<BR>
<BLOCKQUOTE TYPE=3DCITE style=3D"BORDER-LEFT: #0000ff 2px solid; MARGIN-LEFT=
: 5px; MARGIN-RIGHT: 0px; PADDING-LEFT: 5px"></FONT><FONT  COLOR=3D"#0000ff"=
 style=3D"BACKGROUND-COLOR: #ffffff" SIZE=3D2 FAMILY=3D"SANSSERIF" FACE=3D"A=
rial" LANG=3D"0">FAST does not help decision making in haemodynamically stab=
le blunt abdominal trauma.</FONT><FONT  COLOR=3D"#000000" style=3D"BACKGROUN=
D-COLOR: #ffffff" SIZE=3D3 FAMILY=3D"SANSSERIF" FACE=3D"Arial" LANG=3D"0"><B=
R>
 </FONT><FONT  COLOR=3D"#0000ff" style=3D"BACKGROUND-COLOR: #ffffff" SIZE=
=3D2 FAMILY=3D"SANSSERIF" FACE=3D"Arial" LANG=3D"0">FAST positive -&gt; CT.&=
nbsp; FAST negative -&gt; CT.</FONT><FONT  COLOR=3D"#000000" style=3D"BACKGR=
OUND-COLOR: #ffffff" SIZE=3D3 FAMILY=3D"SANSSERIF" FACE=3D"Arial" LANG=3D"0"=
><BR>
 </FONT><FONT  COLOR=3D"#0000ff" style=3D"BACKGROUND-COLOR: #ffffff" SIZE=
=3D2 FAMILY=3D"SANSSERIF" FACE=3D"Arial" LANG=3D"0">Good practice though.</F=
ONT><FONT  COLOR=3D"#000000" style=3D"BACKGROUND-COLOR: #ffffff" SIZE=3D3 FA=
MILY=3D"SANSSERIF" FACE=3D"Arial" LANG=3D"0"><BR>
</BLOCKQUOTE><BR>
</FONT><FONT  COLOR=3D"#000000" style=3D"BACKGROUND-COLOR: #ffffff" SIZE=3D2=
 FAMILY=3D"SANSSERIF" FACE=3D"Arial" LANG=3D"0"><BR>
Maybe this is what you practice, Karim, but you are wrong to generalize so o=
n behalf of everyone else. You need to qualify assertions like that above as=
 "in our hands...." In fact we use the FAST in many settings in stable patie=
nts in whom there is some evidence of abdominal trauma--i.e. complaint of ab=
dominal pain, unconscious with appropriate mechanism, history of hypotension=
 at the scene but stable now, etc.&nbsp; If it is negative we go no further=20=
except serial exam--if positive, as said, we will CT.&nbsp; <BR>
&nbsp;&nbsp;&nbsp;&nbsp; The FAST is most useful in this way as the initial,=
 and if negative, the only screen in stable patients.&nbsp; If negative, we=20=
do continue to observe only--a neg FAST is not sufficient to discharge a pat=
ient.&nbsp; If the patient has no other reason for hospitalization, however,=
 than the possibility of abdominal organ injury, we then will CT--because if=
 the CT is negative, that IS sufficient for then discharging the patient (Li=
vingston et al, J of Trauma Feb 1998).&nbsp; Many do use the abd CT as this=20=
initial screen, like you, which also works--just more expensive and more rad=
iation, and more charge to the patient.&nbsp; Using FAST in this way works J=
UST as well, with a great reduction in the need for CT--as our study in J of=
 T 1997 (Imami et al, Throughput Analysis...) showed comparing the six month=
s before and six months after our adoption of FAST, with no change in patien=
t outcome, and as many other centers have also demonstrated since--and, of c=
ourse, no study has yet refuted.<BR>
ERF</FONT></HTML>

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