MSS14: "BLIND SPOTS" OF EMERGENCY ABDOMINAL ULTRASOUND DURING MASS ADMISSION OF INJURIED.
Oksana Popova, MD, PhD Student1; Kostiantyn Gumeniuk2; 1Military Medical Clinical Center of the Eastern Region, NGO ELLING Training Center - Dnipro, Ukraine; 2Medical Forces Command of Ukrainian Armed Forces, Ukrainian Military Medical Academy - Kiyv, Ukraine
Objectives: FAST is "gold standard" of emergency US for abdominal trauma. However, in the experience of war in Ukraine in 2014-2022, we had seen that the FAST has a few "blind spots", in particular, regarding the diagnosis of colon damage and retroperitoneal hematomas.
Methods: We had added a few criteria and positions to the FAST for assisting injuried with combat abdominal trauma:
- examination of the right iliac region with assessment of the caecum diameter;
- assessment of retroperitoneal hematoma was added to examination in the standard positions of the FAST.
As we found earlier in a case series, a decrease in the diameter of the cecum of less than 40mm is a specific sonographic sign of colon injury(CI). We decided to use this criterion to detect CI.
Verification of the effectiveness of proposed additions to the standard FAST was carried out in 2 stages:
1. Comparison of retrospective data on the use of the standard FAST procedure during the Joint Forces Operation 2014-2021 and the improved procedure, which we began to apply separately in January 2022 and systematically - after 24-February-2022.
2. Comparison of results for FAST with and without additional criteria for assessment injuried with PAT received after 24-February-2022.
Results:
|
Standard FAST (2014-2021 yy.) n=2012 |
Advanced FAST (after 24-Feb-2022 y.) n=1179 |
|
|
Rate of intraabdominal injuries detected during procedure |
82,4%(1657 cases) |
92,2%(1087 cases) |
| Early mortality rate | 7%(141 cases) | 5,4%(64 cases) |
| Early complications rate | 12%(241 cases) | 6%(71 cases) |
|
Standard FAST (after 24-Feb-2022 y.) n=1179 |
Advanced FAST (after24-Feb-2022 y.) n=1179 |
|
|
Rate of intraabdominal injuries detected during procedure |
82,9%(977 cases) |
92,2%(1087 cases) |
Conclusions:
1. Improving of emergency abdominal ultrasound in accordance with the requirements of military medicine is a necessary measure that reduces early mortality and complications among the injuried with PAT.
2. Proposed changes are easy-to-implement additions to the standard FAST procedure that allow detected of colon damage and assess of retroperitoneal hematoma.
3. The use of the improved protocol has a positive effect on the results of treatment for injuried with PAT, reducing early mortality(p-value<0.05).