Ulus Travma Acil Cerrahi Derg. 2011; 17(2): 113-116 | DOI: 10.5505/tjtes.2011.88557

Acil serviste paramediklerce uygulanan travmaya odaklanmýþ ultrasonografi deðerlendirmesi

Erol Erden Ünlüer¹, Özcan Yavaþi¹, Pýnar Hanife Kara¹, Turgay Yýlmaz Kýlýç¹, Nergis Vandenberk¹, Kamil Kayayurt¹, Sevda Kýyançiçek¹, Haldun Akoðlu², Cengiz Yýlmaz^3
1Ýzmir Atatürk Eðitim Ve Araþtýrma Hastanesi, Acil Týp Kliniði, Ýzmir
²Dr. Lütfü Kýrdar Kartal Eðitim Ve Araþtýrma Hastanesi, Acil Týp Kliniði, Ýstanbul
³Bozyaka Eðitim Ve Araþtýrma Hastanesi, Radyoloji Kliniði, Ýzmir

AMAÇ: Travmayý takiben acil servise baþvuran hastalarda paramediklerce uygulanan travmaya odaklanmýþ ultrasonografi deðerlendirmesinin (PFAST) serbest sývý saptamadaki doðruluðu araþtýrýldý.
GEREÇ VE YÖNTEM: Dört saatlik teorik ve dört saatlik uygulamalý eðitim sonrasý,
dört paramedik travma hastalarýný ileriye dönük inceledi. Altýn standardýmýz ultrasonografi ve karýn bilgisayarlý tomografisinin (KBT) resmi radyolog raporlarýydý.
PFAST’in duyarlýlýk, seçicilik, pozitif ve negatif olabilirlik oranlarý ve tanýsal odds oraný hesaplandý ve ki-kare testi ile SPSS 15.0 kullanýlarak analiz edildi.
BULGULAR: Yüz yirmi yedi hasta paramedikler tarafýndan deðerlendirildi. On dört hastada karýnda serbest sývý vardý. Bunlardan 11 tanesi radyoloji raporlarýyla ve KBT ile uyumlu iken (gerçek pozitifler), üç tanesi negatif geldi (yanlýþ pozitifler). Yüz on üç olguda PFAST serbest sývý için negatif idi. Bunlardan 111 tanesinde serbest sývý yokken (gerçek negatifler), iki tanesinde KBT ile tespit edildi (yanlýþ negatifler). Sýrasýyla duyarlýlýk, seçicilik, pozitif ve negatif olabilirlik oranlarý ve tanýsal odds oraný 84,62, 97,37, 32,15, 0,16 ve 203,50 idi.
SONUÇ: Çalýþmamýz, hastane acil servislerinde paramediklerin yüksek doðruluk oranýyla FAST uygulayabileceklerini göstermektedir.

Anahtar Kelimeler: Karýn travmasý, acil servis; acil týp teknisyeni; hastane; hemþire; ultrasonografi

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Paramedic-performed Focused Assessment with Sonography in Trauma (FAST) in the Emergency Department

Erol Erden Ünlüer¹, Özcan Yavaþi¹, Pýnar Hanife Kara¹, Turgay Yýlmaz Kýlýç¹, Nergis Vandenberk¹, Kamil Kayayurt¹, Sevda Kýyançiçek¹, Haldun Akoðlu², Cengiz Yýlmaz^3
1Department Of Emergency Medicine, Izmir Ataturk Training And Research Hospital, Ýzmir, Turkey
²Department Of Emergency Medicine, Dr. Lütfü Kýrdar Kartal Training And Research Hospital, Ýstanbul, Turkey
³Department Of Radiology, Bozyaka Training And Research Hospital, Ýzmir, Turkey

BACKGROUND: Our objective was to evaluate the accuracy of paramedicperformed
Focused Assessment with Sonography in Trauma (PFAST) for detection of free fluid in patients admitted to the Emergency Department (ED) following trauma.
METHODS: After four hours of didactic and four hours of hands-on training, four paramedics prospectively evaluated trauma patients. Our gold standard was the official radiologist reports of ultrasonography and computerized abdominal tomography (CAT). The sensitivity, specificity, positive and negative likelihood ratios, and diagnostic odds ratio of PFAST were calculated and analyzed using SPSS 15.0 with χ2 testing.
RESULTS: One hundred and twenty-seven patients were evaluated by the paramedics. Fourteen patients had positive free fluid in the abdomen. Of these, 11 were corroborated by radiology reports and CAT (true positives), and three were found to be negative (false positives). In 113 cases, PFAST was negative for free fluid. Of these, 111 were determined not to have free fluid (true negatives), whereas free fluid was detected by CAT in 2 (false negatives). The sensitivity, specificity, positive and negative likelihood ratios, and diagnostic odds ratio of PFAST were 84.62, 97.37, 32.15, 0.16, and 203.50, respectively.
CONCLUSION: Our study shows that paramedics can perform FAST in hospital EDs with a high degree of accuracy.

Keywords: Abdominal injury, emergency service; emergency medical technicians; hospital; nurse; ultrasonography

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