Toraks Travmalı Hastalarda Ca-Fast ve Nexus Chest Bt Kriterlerinin Kıyaslanması

Abstract

Olmez H. Comparison of CA-FAST and NEXUS Chest CT Criteria in Thoracic Trauma. Hacettepe University Faculty of Medicine, Thesis of Emergency Medicine, Ankara 2020. Rapid diagnosis and treatment in trauma patients is crucial for early stabilization at the Emergency Department. Computed tomography (CT) is the most important step of thoracic injury workup. NEXUS Chest CT is a set of criterias used to decide on the need for chest imaging in patients with blunt thoracic trauma. It is based on the patient's clinical status, age and the mechanism of the trauma. CA-FAST (Chest Abdominal- Focused Assessment with Sonography for Trauma) is a method that is used for evaluation of both chest and abdominal trauma by ultrasonography (USG). In our study, it was aimed to determine the diagnostic value of CA-FAST evaluation based on NEXUS Chest CT criteria in patients who admitted to the emergency department with blunt thoracic trauma. This is a prospective study involving 668 patients. Most common cause of admission was motor vehicle accidents with a rate of 46,4%. Most frequent finding on thoracic CT were rib fractures (14,7%), and it is followed by vertebral fractures (3,7%), pneumothoraks (2,7%), lung contusion (1,2%), and hemothorax (0,7%). In patients with pathological findings in CA-FAST, blood pressure and oxygen saturation was lower and pulse was higher than in patients with normal CA-FAST. CA-FAST has sensitivity of 48.39%, specificity of 99.69%, and NPD of 97,54% for thoracic injury. CA-FAST has sensitivity of 55.56%, specificity of 99.85% and NPD of 98.78% for pneumothorax. CA-FAST has sensitivity of 75.0%, specificity of 99.70% and NPD of 99.85% for hemothorax. CA- FAST has sensitivity of 25.0%, specificity of 100.0% and NPD of 99.1% for lung contusion. The rate of pathological findings in the CA-FAST was 3.4% in patients who were hospitalized in wards and 31.7% in patients who were hospitalized in ICU or died. It was concluded that CA-FAST may be useful in predicting the need for hospitalization in thoracic trauma. CA-FAST have low sensitivity in detecting pneumothorax, hemothorax and lung contusion. In conclusion, the clinician should consider the clinical condition of the patient in addition to the CA-FAST results when making the thorax CT imaging decision.