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{
    "pk": 9708,
    "title": "Caudal Edge of the Liver in the Right Upper Quadrant (RUQ) View Is the Most Sensitive Area for Free Fluid on the FAST Exam",
    "subtitle": null,
    "abstract": "INTRODUCTION\n \nThe Focused Assessment with Sonography in Trauma (FAST) exam is a critical diagnostic test for intraperitoneal free fluid (FF). Current teaching is that fluid accumulates first in Morison’s pouch. The goal of this study was to evaluate the “sub-quadrants” of traditional FAST views to determine the most sensitive areas for FF accumulation.\n \n \n \nMETHODS\n \nWe analyzed a retrospective cohort of all adult trauma patients who had a recorded FAST exam by emergency medicine (EM) physicians at a Level 1 trauma center from January 2012 – June 2013. Ultrasound fellowship-trained faculty with three EM residents reviewed all FAST exams. Studies were excluded if they were incomplete, of poor image quality, or with incorrect medical record information. Positive studies were assessed for FF localization, comparing the traditional abdominal views and on a sub-quadrant basis: RUQ1 - hepato-diaphragmatic, RUQ2 - Morison’s pouch, RUQ3 - caudal liver edge and superior paracolic gutter, LUQ1 - splenic-diaphragmatic, LUQ2 - spleno-renal, LUQ3 – around inferior pole of kidney, SP1 - bilateral to bladder, SP2 - posterior to bladder, SP3 – posterior to uterus (females).  FAST results were confirmed by chart review of computed tomography (CT) results or operative findings.\n \n \n \nRESULTS\n \nOf the included 1008 scans, 48 (4.8%) were positive. The RUQ was the most positive view with 32/48 (66.7%) positive. In the RUQ sub-quadrant analysis, the most positive view was the RUQ3 with 30/32 (93.8%) positive.\n \n \n \nCONSLUSIONS\n \nThe RUQ is most sensitive for FF assessment with the superior paracolic gutter area around the caudal liver edge (RUQ3) being the most positive sub-quadrant within the RUQ.",
    "language": "en",
    "license": {
        "name": "Creative Commons Attribution 4.0",
        "short_name": "CC BY 4.0",
        "text": "Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.\r\n\r\nNo additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.",
        "url": "https://creativecommons.org/licenses/by/4.0"
    },
    "keywords": [
        {
            "word": "FAST, Free fluid, trauma, RUQ, ATLS, Emergency Medicine, Point of Care"
        }
    ],
    "section": "Technology in Emergency Medicine",
    "is_remote": true,
    "remote_url": "https://escholarship.org/uc/item/2wh596n6",
    "frozenauthors": [
        {
            "first_name": "Viveta",
            "middle_name": "",
            "last_name": "Lobo",
            "name_suffix": "",
            "institution": "Stanford University",
            "department": "None"
        },
        {
            "first_name": "Michelle",
            "middle_name": "",
            "last_name": "Hunter-Behrend",
            "name_suffix": "",
            "institution": "Stanford University",
            "department": "None"
        },
        {
            "first_name": "Erin",
            "middle_name": "",
            "last_name": "Cullnan",
            "name_suffix": "",
            "institution": "Stanford University",
            "department": "None"
        },
        {
            "first_name": "Rebecca",
            "middle_name": "",
            "last_name": "Higbee",
            "name_suffix": "",
            "institution": "Stanford University",
            "department": "None"
        },
        {
            "first_name": "Caleb",
            "middle_name": "",
            "last_name": "Philips",
            "name_suffix": "",
            "institution": "University of Colorado",
            "department": "None"
        },
        {
            "first_name": "Sarah",
            "middle_name": "",
            "last_name": "Williams",
            "name_suffix": "",
            "institution": "Stanford University",
            "department": "None"
        },
        {
            "first_name": "Phillips",
            "middle_name": "",
            "last_name": "Perera",
            "name_suffix": "",
            "institution": "Stanford University",
            "department": "None"
        },
        {
            "first_name": "Laleh",
            "middle_name": "",
            "last_name": "Gharahbaghian",
            "name_suffix": "",
            "institution": "Stanford University",
            "department": "None"
        }
    ],
    "date_submitted": "2016-03-21T17:31:21Z",
    "date_accepted": "2016-03-21T17:31:21Z",
    "date_published": "2017-01-19T20:30:43Z",
    "render_galley": null,
    "galleys": [
        {
            "label": "",
            "type": "pdf",
            "path": "https://journalpub.escholarship.org/westjem/article/9708/galley/5379/download/"
        }
    ]
}