Evaluation and management of blunt injury abdomen based on focussed assessment with sonography in trauma

Sameer Ahmed


Background: The initial evaluation of patient with multiple trauma is a challenging task. FAST (focussed assessment with sonography in trauma) provides a viable alternative to computed tomography in blunt abdominal trauma patient. The aim of this study was to find the accuracy and utility of FAST in clinical decision making, as well as limitations.

Methods: A total of 100 patients with blunt abdominal trauma who underwent FAST examination were included. Positive scan was defined as the presence of free intraperitoneal fluid. The sonographic scoring for operating room triage in trauma (SSORTT Score) was calculated using cumulative sum of ultrasound score, systolic blood pressure, and pulse rate. FAST findings were compared with computed tomography findings and in operated cases compared with surgical findings & clinical outcome.

Results: We determined SSORTT score in all 100 cases. In our study, the sensitivity, specificity, positive and negative predictive values for FAST in identifying intraabdominal injuries were 93.9%, 94.2%, 87.5%, and 97.2%. In our study we found out that patients with a SSORTT score of 2 and above had a high likelihood of requiring a therapeutic laparotomy.

Conclusions: In our study we found that FAST is a rapid, reproducible, portable and non-invasive bedside test, and can be performed at the same time as resuscitation. Ultrasound is limited mainly by its low sensitivity in directly demonstrating solid organs injuries.


Abdominal trauma, Focussed assessment with sonography in trauma, Computed tomography, Management

Full Text:



Krug EG, Sharma GK, Lozano R. The global burden of injuries. Am J Public Health. 2000, 90:523-6.

Perry JF. A Five-year survey of 152 acute abdominal injuries. J Trauma. 1965; 5:53-7.

Elton C, Riaz AA, Young N, Schamschula R, Papadopoulos B, Malka V. Accuracy of computed tomography in the detection of blunt bowel and mesenteric injuries. Br J Surg. 2005;92:1024-8

Ochsner MG, Knudson MM, Pachter HL, Hoyt DB, Cogbill TH. Significance of minimal or no intraperitoneal fluid visible on CT scan associated with blunt liver and splenic injuries: a multicenter analysis. J Trauma. 2000;49:505-10.

Nural MS, Yarden T, Guven H, Baydin A, Bayrak IK, Kati C. Diagnostic value of u/s in evaluation of blunt abdominal trauma. Diagn Interv Rad. 2005;11:41-4.

Kristensen JR, Bueman B, Keuhl E. Ultrasonic scanning in the diagnosis of splenic haematomas. Acta Chir Scand. 1971;137:653-7.

Kirkpatrick AW. Clinician-performed focused sonography for the resuscitation of trauma. Crit Care Med. 2007;35:S162-72.

Bakker J, Gender R, Mali W, Leenen L. Sonography as the primary screening method in evaluating blunt abdominal trauma. J Clinic Ultras. 2005;33:155-63.

Tso P, Rodriguez A, Cooper C, Militello P, Mirvis S, Badellino MM, et al. Sonography in blunt abdominal trauma: a preliminary progress report. J Trauma. 1992;33(1):39-43.

MacLeod JB, Lynn M, McKenney MG, Cohn SM, Murtha M. Early coagulopathy predicts mortality in trauma. J Trauma Acute Ca Surg. 2003;55(1):39-44.

Katz S, Lazar L, Rathaus V, Erez I. Can ultrasonography replace computed tomography in the initial assessment of children with blunt abdominal trauma? J Pediatr Surg. 1996;31:649-51.

Yoshii H, Sato M, Yamamoto S. Usefulness and limitations of ultrasonography in the initial evaluation of blunt abdominal trauma. J Trauma. 1998;45:45-51.

Richards JR, Schleper NH, Woo BD, Bohnen PA, McGahan JP. Sonographic assessment of blunt abdominal trauma: a 4-year prospective study. J Clin Ultrasound. 2002;30:59-67.

Brown MA, Casola G, Sirlin CB, Patel NY, Hoyt DB. Blunt abdominal trauma: screening US in 2,693 patients. Radiol. 2001;218:352-8.

Ng AK, Simons RK, Torreggiani WC, Ho SG, Kirkpatrick AW, Brown DR. Intraabdominal free fluid without solid organ injury in blunt abdominal trauma: an indication for laparotomy. J Trauma. 2002;52:1134-40.

Brasel KJ, Olson CJ, Stafford RE, Johnson TJ. Incidence and significance of free fluid on abdominal computed tomographic scan in blunt trauma. J Trauma. 1998;44:889-92.

McKenney M, Lentz K, Nunez D, et al. Can ultrasound replace diagnostic peritoneal lavage in the assessment of blunt trauma? J Trauma 1994;37:439-41.

Musiitwa M, Claver P. Sonographic scoring for operating room triage in trauma; accuracy for therapeutic laparotomy among blunt abdominal trauma patients in Mulago Hospital (Doctoral dissertation, Makerere University). 2020.