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2017 ; 9
(1
): 8
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The FAST D protocol: a simple method to rule out traumatic vascular injuries of
the lower extremities
#MMPMID28324353
Montorfano MA
; Montorfano LM
; Perez Quirante F
; Rodríguez F
; Vera L
; Neri L
Crit Ultrasound J
2017[Dec]; 9
(1
): 8
PMID28324353
show ga
BACKGROUND: The aim of this study is to assess the accuracy of a Fast Doppler
protocol for the examination of an injured lower limb, namely 2-Point Fast
Doppler (2PFD), in order to rapidly triage arterial lesions after penetrating
trauma. METHODS: The presence of flow and the aspects of the Doppler waveform of
the dorsalis pedis artery (DPA) and posterior tibial artery (PTA) of the injured
lower limb (2PFD) were evaluated immediately before the execution of a
standardized Color Duplex Doppler (SD) evaluation in 149 limbs of 140 patients
with gunshot penetrating injuries. We considered 2PFD normal exams as the ones
with triphasic patterns in both the DPA and PTA, and 2PFD pathologic exams as the
ones with absent, biphasic, or monophasic flow patterns in the DPA and/or PTA.
2PFD data were then analyzed to assess accuracy variables, using SD results as
matching test reference. According to the trauma center standard protocols, SD
positive cases underwent also angiography and surgical exploration, whose
findings were used to further match the 2PFD specificity. RESULTS: The 2PFD
protocol showed a sensitivity of 100%, and a specificity of 100% compared with
the SD, in the diagnostic workup of arterial injuries of the lower limbs after
penetrating trauma. Furthermore, all the pathologic cases that resulted in all
true positives (TP), compared with SD, were confirmed as TP also when matched
with the angiography evaluation results. CONCLUSIONS: The 2PFD protocol can
rapidly identify arterial flow and differentiate between normal and pathologic
spectral Doppler analyses in distal arteries. The presence of the normal
triphasic flows in DPA and PTA is as sensitive as the standardized Color Doppler
Duplex assessment of the entire limb in ruling out arterial lesions in lower-limb
penetrating trauma. The absence of flow or the presence of a biphasic or
monophasic pathologic flow in DPA and PTA is pathologic and should be always
followed by further investigation. 2PFD is faster and easier to perform compared
with the SD approach. It could become a new first-line screening technique, both
in pre-hospital and hospital critical scenarios, particularly in contexts where
advanced diagnostic performance is limited by time concerns or scarce resources.
free
free
free
