Abstract
Background
Imaging protocols for maternal major trauma during pregnancy are not standardized,
and it is uncertain whether focused assessment with sonography for trauma (FAST) or
computed tomography of the abdomen/pelvis (CTAP) is preferred for detecting intra-abdominal
hemorrhage.
Objective
To estimate the accuracy of the FAST exam compared to CTAP, validate imaging accuracy
with clinical outcomes, and describe clinical factors associated with each imaging
mode.
Study Design
A retrospective cohort study of pregnant patients evaluated for major trauma at one
of two Level 1 trauma centers between 2003 and 2019. We identified 4 imaging groups:
no intra-abdominal imaging, FAST only, CTAP only, and both FAST and CTAP. The primary
outcome was a composite maternal severe adverse pregnancy outcome, including death
and intensive care unit admission. We estimated sensitivity, specificity, and positive
and negative predictive values of FAST for hemorrhage with reference CTAP. We performed
ANOVA and chi-squared tests to compare clinical factors and outcomes across imaging
groups. Multinomial logistic regression was used to estimate associations between
selected imaging mode and clinical factors.
Results
Of 119 pregnant trauma patients, 31 (26.1%) experienced a maternal severe adverse
pregnancy outcome. Intra-abdominal imaging modes included none in 37.0%, FAST only
in 21.0%, CTAP only in 25.2%, and both modes in 16.8%. With CTAP as the reference,
FAST exam had sensitivity, specificity, positive predictive value, and negative predictive
value of 11%, 91%, 50%, and 55%, respectively. One patient had a maternal severe adverse
pregnancy outcome with a positive FAST and negative CTAP and two patients with a positive
CTAP did not have an adverse outcome. Use of CTAP with or without FAST exam was associated
with a higher injury severity score, lower systolic blood pressure nadir, higher motor
vehicle collision speed, and higher rates of hypotension, tachycardia, bone fracture,
maternal severe adverse pregnancy outcome and fetal demise. The association of CTAP
use with higher injury severity score, tachycardia, and lower systolic blood pressure
nadir persisted in multivariable analysis. With each 1-point increase in the ISS,
there was an 11% more likelihood of using CTAP over FAST exam for intra-abdominal
imaging.
Conclusion
The sensitivity of FAST in detecting intra-abdominal hemorrhage in pregnant trauma
patients is poor, and CTAP has a low false-negative rate. Providers appear to prefer
CTAP to FAST in patients with the most severe trauma. CTAP with or without FAST is
more accurate than FAST alone.
Keywords
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Article info
Publication history
Accepted:
February 28,
2023
Received in revised form:
February 18,
2023
Received:
December 12,
2022
Publication stage
In Press Accepted ManuscriptIdentification
Copyright
© 2023 Elsevier Inc. All rights reserved.
