Article Text

Ultrasonography in thoracic and abdominal stab wound injury: results from the FETTHA study
  1. Donia Bouzid1,2,3,4,
  2. Alexy Tran-Dinh1,5,6,
  3. Brice Lortat-Jacob5,
  4. Enora Atchade5,
  5. Sylvain Jean-Baptiste5,
  6. Parvine Tashk5,
  7. Aurelie Snauwaert5,
  8. Nathalie Zappella5,
  9. Pascal Augustin5,
  10. Quentin Pellenc7,
  11. Yves Castier1,6,7,
  12. Lara Ribeiro8,
  13. Augustin Gaudemer9,
  14. Antoine Khalil1,9,10,
  15. Philippe Montravers1,5,10,
  16. Sebastien Tanaka5,11
  17. on behalf of the Bichat stab wounds injury study group
    1. 1 Université Paris Cité, Paris, France
    2. 2 INSERM UMR1137, IAME, F-75006, Paris, France
    3. 3 Université de Montpellier, VBMI, INSERM U1047, Nimes, France
    4. 4 AP-HP Nord, Emergency Department, Bichat-Claude Bernard University Hospital, Paris, France
    5. 5 AP-HP Nord, Anesthesiology and Intensive Care Department, Bichat-Claude Bernard University Hospital, Paris, France
    6. 6 INSERM UMR1148, Paris, France
    7. 7 AP-HP Nord, Thoracic and Vascular Surgery Department, Bichat-Claude Bernard University Hospital, Paris, France
    8. 8 AP-HP Nord, Visceral Surgery Department, Bichat-Claude Bernard University Hospital, Paris, France
    9. 9 AP-HP Nord, Radiology Department, Bichat-Claude Bernard University Hospital, Paris, France
    10. 10 PHERE, Physiopathology and Epidemiology of Respiratory Diseases, French Institute of Health and Medical Research (INSERM) U1152, Paris, France
    11. 11 INSERM UMR1188, Saint-Denis de la Réunion, France
    1. Correspondence to Dr Sebastien Tanaka, APHP, Paris, Île-de-France, France; sebastien.tanaka{at}aphp.fr

    Abstract

    Background While the role of Extended Focused Assessment with Sonography in Trauma (eFAST) is well defined in the management of severe blunt trauma, its performance in injuries caused by stab wounds has been poorly assessed.

    Methods Prospective single centre study which included all patients with stab wounds to the thorax or abdomen between December 2016 and December 2018. All patients underwent initial investigation with both eFAST and CT scan, except in cases of haemodynamic or respiratory instability, and in cases with a positive diagnosis by eFAST in which case surgery without CT scan was performed.

    Results Of the 200 consecutive patients included, 14 unstable patients underwent surgery immediately after eFAST. In these 14 patients, 9 had cardiac tamponade identified by eFAST and all were confirmed by surgery. In the remaining 186 patients, the median time between eFAST and CT scan was 30 min (IQR 20–49 min). Test characteristics (including 95% CI) for eFAST compared with reference standard of CT scan for detecting pneumothorax were as follows: sensitivity 77% (54%–92%), specificity 93% (90%–97%), positive predictive value (PPV) 60% (49%–83%), negative predictive value (NPV) 97% (93%–99%). Test characteristics (including 95% CI) for eFAST compared with CT scan for detecting haemothorax were as follows: sensitivity 97% (74%–99%), specificity 96% (92%–98%), PPV 83% (63%–93%) and NPV 99% (96%–100%). Finally, test characteristics (including 95% CI) for eFAST compared with CT scan for detecting haemoperitoneum were as follows: sensitivity 75% (35%–97%), specificity 97% (93%–99%), PPV 55% (23%–83%) and NPV 99% (96%–99%).

    Conclusions In patients admitted with stab wounds to the torso, eFAST was not sensitive enough to diagnose pneumothorax and haemoperitoneum, but performed better in the detection of cardiac tamponade and haemothorax than the other injuries. More robust multicentre studies are needed to better define the role of eFAST in this specific population.

    • Ultrasonography
    • wounds and injuries
    • abdomen
    • chest
    • ultrasonography

    Data availability statement

    Data are available upon reasonable request.

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    Data availability statement

    Data are available upon reasonable request.

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    Footnotes

    • Handling editor Jason E Smith

    • Collaborators Bichat stab wounds injury study group: AH, AEK, AY, AM, AS, AG, BP, MA, NC, CDT, CD, DL, EK, FL, IB, JS, LS, LC, MR, MBR, RS, YR, SR, SB, SY, JV, PM, AG, AR, JS, KA, LR, SM.

    • Contributors DB, ST and PM contributed to study concept and design. DB and ST performed statistical analysis. DB, ST, ATD, BLJ, EA, SJB, PT, AS, NZ, PA, QP, YC, LR and PM were involved in patient care and data collection. AG and AK blindly interpreted CT scan data. DB, ST, ATD, EA, NZ and PM were involved in data analysis and interpretation. DB, ST, ATD and PM performed critical revision of the manuscript. All the authors read and approved the final manuscript. ST is the guarantor.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting or dissemination plans of this research.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.