Consequencies of therapeutic decision-making based on FAST results in trauma patients with pelvic fracture

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These fractures are associated with a high risk of mortality that may even reach 45%, a mean injury severity score (ISS)<a class="elsevierStyleCrossRef" href="#bib0005">1</a> of 50 and associated injuries in more than 90% of cases.<a class="elsevierStyleCrossRefs" href="#bib0010">2–4</a>Hemodynamically unstable polytrauma patients with pelvic fracture require rapid and effective initial evaluation that allows for appropriate treatment to be initiated as soon as possible to achieve the best results. Focused Abdominal Sonography for Trauma (FAST)<a class="elsevierStyleCrossRefs" href="#bib0025">5,6</a> is an essential non-invasive tool used for rapid evaluation of the abdomen in order to detect hemoperitoneum. According to well-standardized studies and protocols,<a class="elsevierStyleCrossRef" href="#bib0035">7</a> the presence of hemoperitoneum is an indicator of intra-abdominal injury requiring immediate surgical intervention. Meanwhile, hemodynamically unstable patients with pelvic fracture and negative FAST require pelvic angioembolization or preperitoneal packing, depending on the therapeutic possibilities.<a class="elsevierStyleCrossRefs" href="#bib0035">7,8</a>FAST has a sensitivity >87% and a specificity >92% to detect the presence or absence of hemoperitoneum in polytrauma patients with hypovolemic shock.<a class="elsevierStyleCrossRefs" href="#bib0035">7,8</a> These values decrease significantly when the trauma involves pelvic fracture because the false positive and false negative rates increase considerably. In patients with pelvic fracture, the FAST achieves a sensitivity that ranges between 26% and 65%, and a specificity that ranges from 80% to 90%.<a class="elsevierStyleCrossRefs" href="#bib0045">9–13</a>The hypothesis of the study is that the low sensitivity and specificity of FAST in polytrauma patients with pelvic fracture leads to a greater number of unnecessary laparotomies and a delay in the angiographic treatment needed.The main objective of our study is to assess the validity of FAST in polytrauma patients with a pelvic fracture and to analyze the clinical consequences of therapeutic decision-making based on its results.MethodsWe present a retrospective, descriptive study of polytrauma patients with pelvic fracture over the age of 16 who were either admitted to the critical care unit or died.The patients were prospectively registered in a protected Access® database from March 2006 until today. The following variables were collected for each case: age, sex, mechanism of action, ISS 8, Revised Trauma Score (RTS),<a class="elsevierStyleCrossRef" href="#bib0070">14</a> prehospital and hospital vital signs, complementary tests performed, diagnosis and treatment of each injury, complications and resolution of the case, specifying the date and cause of death if the patient has died.When FAST was used,<a class="elsevierStyleCrossRefs" href="#bib0025">5,6</a> two possible results have been reported: positive, when free fluid was observed in the abdominal cavity; or negative, when free fluid was not observed in the abdominal cavity. For the purpose of this study, we did not perform pericardial FAST.A standard reference in surgical patients is the presence or absence of pathological findings. For our study, the presence of pathological findings was defined as a necessary laparotomy (hemoperitoneum >500 cc and injuries requiring surgical treatment). The absence of pathological findings was defined as an unnecessary laparotomy (no pathological findings, or minor injuries requiring no surgical treatment).The standard reference study in non-operated patients was computed tomography (CT) scan. The presence of pathological findings was defined as CT findings requiring surgical treatment. The absence of pathological findings was defined as either a normal CT scan or pathological findings on CT that required nonsurgical treatment.We compared the FAST results with the standard reference tests depending on whether the hemodynamically unstable patients (systolic blood pressure ≤90 or heart rate ≥100) underwent laparotomy.Statistical analysisThe descriptive analysis was presented as mean and standard deviation for continuous variables and as percentages for categorical variables.We calculated the sensitivity, specificity, positive predictive value and negative predictive value of the FAST. There were no missing data.<a class="elsevierStyleCrossRefs" href="#bib0075">15,16</a>We have followed the STARD<a class="elsevierStyleCrossRef" href="#bib0085">17</a> method for reporting the results.The Student’s t test and the chi-square test were used to compare groups after confirming the normality of the variables and the homoscedasticity of the variance. For the analysis of numerical variables that did not comply with the laws of normality, a non-parametric Mann–Whitney U test was used. IBM SPSS 21.0® was used for the different statistical calculations.ResultsIn a 13-year period, from March 2006 to March 2019, we registered 1826 patients over the age of 16 with multiple injuries who were either admitted to the critical care unit or died, 14.4% of which (263 patients) presented pelvic fracture. Out of the 263 patients with pelvic fracture, 78 hemodynamically unstable patients studied by FAST were included in our study (see STARD diagram, <a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>).<elsevierMultimedia ident="fig0005"></elsevierMultimedia>The mean age of the polytrauma patients with pelvic fracture was 49, and 67% of the patients were men. The mechanism of action was mainly blunt trauma (99%), and the most frequent causes were traffic accidents and falls (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>).<elsevierMultimedia ident="tbl0005"></elsevierMultimedia>The mean ISS 1 was 31 (SD 16), which was clearly higher than the mean ISS for patients with multiple injuries registered in our hospital (ISS 19, SD 14). Mortality was 19%, which was also higher than the mortality rate of the global series (10.8%). The main cause of death varied from neurological causes in the general group to hypovolemic shock when the patient presented pelvic fracture (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>).Out of the 263 polytrauma patients with pelvic fracture, FAST was performed in 98 (37%): 39 positive, and 59 negative.In our series, 144 patients were hemodynamically stable, and FAST was performed in 14% (20 patients), despite their stability. Out of the 119 hemodynamically unstable patients, the FAST score was analyzed in 66% (78), finding 46 patients with negative FAST (39%) and 32 with positive FAST (27%) (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>).<elsevierMultimedia ident="fig0010"></elsevierMultimedia>When we analyzed the FAST result versus the actual presence or absence of intra-abdominal bleeding (<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>), we found a false negative rate of 34.8% and a false positive rate of 30.9%. In our series, the sensitivity of FAST was 65.2% (95% CI: 45.75 %–84.68 %), specificity 69% (95% CI: 56.88 %–81.30 %), positive predictive value 46.8% (95% CI: 29.58 %–64.17 %) and negative predictive value 82.6% (95% CI: 71.66 %–93.56 %). 100% of the FAST false negatives (8 patients) required surgical treatment that was delayed due to the performance of an abdominal CT scan in hemodynamically unstable patients. Meanwhile, 58.8% of the FAST false positives (10 patients) underwent an unnecessary laparotomy, causing a delay in the needed angiographic treatment of the pelvic fracture, with active arterial bleeding. We had temporarily stabilized the pelvis of all patients undergoing laparotomy by means of a strap (sheet, belt, or other device suitable for such use). In no case was surgical external fixation used at this point of treatment.<elsevierMultimedia ident="tbl0010"></elsevierMultimedia>The analysis of the number of quadrants where free fluid was observed by FAST (hepatorenal fossa, splenorenal fossa and pelvis) found no differences between true positives and false positives. The mean number of quadrants with free fluid detected by FAST was 2 in the false positive cases and 2.13 in the true positives.When we compared the mortality rate of the different groups of patients, we observed that hemodynamically unstable patients had almost twice the mortality compared to stable patients (27% vs 14%, P < .05). Hemodynamically unstable patients with a positive FAST died more frequently than patients with a negative FAST (43% vs 26%). Although the mortality rate in hemodynamically unstable patients was similar when the FAST was true positive or false positive (40% vs. 41%), 4 out of 10 hemodynamically unstable patients who had undergone unnecessary laparotomy due to a false-positive FAST died from hypovolemic shock secondary to pelvic bleeding. This mortality rate (60%) dropped to 20% when it was associated with preperitoneal packing before angioembolization of the pelvis (<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>).<elsevierMultimedia ident="tbl0015"></elsevierMultimedia>DiscussionIt is already well known<a class="elsevierStyleCrossRefs" href="#bib0015">3,4,7</a> that polytrauma patients with pelvic fracture are a group of patients with greater injury severity (mean ISS 31 vs. 19, P < .05) and a higher percentage of mortality (19% vs 10.8%, P < .05) than patients with multiple trauma injuries in general. The management of hemorrhage is essential in polytrauma patients with pelvic fracture since 48% die due to hypovolemic shock.In our study starting in 2006, abdominal FAST was used to rule out bleeding in 65% of cases. Some 34% of hemodynamically unstable patients endured the risk of transfer for abdominal CT scan without previously ruling out intra-abdominal bleeding using FAST. This coincides with the results published in a multicenter study in Catalonia, where 27%–33% of hemodynamically unstable patients were studied with abdominal CT scan. This percentage did not decrease even after specific training information sessions and the placement of posters in the trauma rooms at different hospitals that provided treatment recommendations for patients with multiple trauma injuries.<a class="elsevierStyleCrossRef" href="#bib0090">18</a>Although the precision of FAST depends on the user, its sensitivity in hemodynamically unstable patients with multiple trauma injuries ranges between 80% and 97%<a class="elsevierStyleCrossRefs" href="#bib0025">5–8</a> and has an extraordinary specificity between 95% and 99.5%.<a class="elsevierStyleCrossRefs" href="#bib0025">5–8</a> When hemodynamically unstable polytrauma patients have fractured pelvis, there is a significant percentage of false positives and false negatives due to interference from the retroperitoneal hematoma associated with the pelvic fracture. The high rate of false positives and false negatives reduces its sensitivity to values between 26% and 65%, and its specificity to between 80% and 90%,<a class="elsevierStyleCrossRefs" href="#bib0045">9–13</a> despite the FAST being performed by examiners with the same experience that achieved a sensitivity and specificity >80%–90% when there is no pelvic fracture. In our hospital, we have identified this significant reduction with a sensitivity of 65.2% and a specificity of 69%, even though the FAST is routinely conducted by radiologists with extensive experience in ultrasound.In general, 200 mL of blood is needed to be able to visualize free fluid using FAST.<a class="elsevierStyleCrossRef" href="#bib0065">13</a> It is scientifically proven that any amount of free fluid observed by FAST is an indication for laparotomy in hemodynamically unstable patients.<a class="elsevierStyleCrossRefs" href="#bib0025">5,6,10</a> The 4 spaces where the presence or absence of free fluid is classically studied with FAST are: cardiac, right flank (hepatic/renal), left flank (splenic/renal), and pelvis (bladder/rectal or uterine).<a class="elsevierStyleCrossRef" href="#bib0030">6</a> In our study, we analyzed whether the number of spaces where free fluid was observed by FAST was associated with a higher rate of false positives versus the rate of true positives. No significant relationship was observed: false positives were found with liquid in 3 quadrants, and very positive values were found with liquid in a single quadrant.As expected, hemodynamically unstable patients die at nearly twice the rate of hemodynamically stable patients (27% vs 14%, P < .05). More than half of polytrauma patients with pelvic fracture die due to hypovolemic shock (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>), and more unstable patients with positive FAST die (43% vs 26%), which is probably associated with having least 2 sources of bleeding instead of one: the pelvis and the abdomen. Although mortality in hemodynamically unstable patients is similar when the FAST is true positive or false positive (40% vs 41%), when we performed an unnecessary laparotomy for a false positive FAST and associated preperitoneal packing before transferring the patient to the relevant destination (angioembolization, Intensive Care Unit, etc.), mortality decreased from 60% to 20%. In these patients, where different and clinically relevant mortality percentages have been found, it has not been possible to analyze their statistical value as the requirements necessary for the chi-square test were not met.The limitation of the current study is the number of cases registered and included in the study, which provides clinically very relevant results, but the statistical significance would improve with a larger sample size. The results can be extrapolated to any population of polytrauma patients with pelvic fracture and hemodynamic instability who undergo FAST.It is not easy to find the origin of bleeding in patients with hypovolemic shock and a fractured pelvis. The influence of the mechanism of action on the origin of the bleeding has been described, and more than 80% of patients with pelvic fracture due to a fall bleed from the pelvis itself, while patients with a pelvic fracture caused by a crash-type mechanism may bleed from either the pelvis or abdomen.<a class="elsevierStyleCrossRef" href="#bib0095">19</a>The lower efficacy of FAST in patients with pelvic fracture forces us to question the consequences of making therapeutic decisions based on its results. Patients with a false positive FAST have higher mortality rates, and we must consider making changes in the treatment of these patients to lower these rates.In addition to the mechanism of injury, we should develop strategies to reduce the rate of false negatives and, especially, false positives in order to optimize appropriate treatment and reduce the mortality rate in hemodynamically unstable patients with polytrauma and pelvic fracture. For this, FAST can be repeated 15−20 min later to compare both results. With this maneuver, the Christian et al. group<a class="elsevierStyleCrossRef" href="#bib0100">20</a> has reduced the rate of false negatives to 2%, but they have found no differences in the rate of false positives.When faced with a positive FAST, Ruchholtz et al.<a class="elsevierStyleCrossRef" href="#bib0105">21</a> always recommend laparotomy because they consider the risk of not performing a necessary laparotomy to be worse than performing unnecessary laparotomies. In our study, although mortality in hemodynamically unstable patients was similar when the FAST was true positive or false positive (40% vs 41%), 4 out of 10 hemodynamically unstable patients underwent unnecessary laparotomies for a false positive FAST and died from hypovolemic shock. This mortality rate (60%) was reduced to 20% when it was associated with preperitoneal packing before moving the patient for angioembolization of the pelvis. Another possibility to reduce mortality when given a positive FAST would be to compare the FAST result with a more invasive but more effective test, such as a diagnostic peritoneal aspiration, especially in patients who have suffered a crash-type mechanism of action, with the intention of reducing the number of unnecessary laparotomies.FundingThe article has received no funding, either public or private.Conflict of interestsThe authors have no conflict of interests to declare." "textoCompletoSecciones" => array:1 [ "secciones" => array:12 [ 0 => array:3 [ "identificador" => "xres1525607" "titulo" => "Graphical abstract" "secciones" => array:1 [ 0 => array:1 [ "identificador" => "abst0005" ] ] ] 1 => array:3 [ "identificador" => "xres1525606" "titulo" => "Abstract" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0010" "titulo" => "Introduction" ] 1 => array:2 [ "identificador" => "abst0015" "titulo" => "Methods" ] 2 => array:2 [ "identificador" => "abst0020" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0025" "titulo" => "Conclusion" ] ] ] 2 => array:2 [ "identificador" => "xpalclavsec1383152" "titulo" => "Keywords" ] 3 => array:3 [ "identificador" => "xres1525605" "titulo" => "Resumen" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0030" "titulo" => "Introducción" ] 1 => array:2 [ "identificador" => "abst0035" "titulo" => "Métodos" ] 2 => array:2 [ "identificador" => "abst0040" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0045" "titulo" => "Conclusiones" ] ] ] 4 => array:2 [ "identificador" => "xpalclavsec1383153" "titulo" => "Palabras clave" ] 5 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 6 => array:3 [ "identificador" => "sec0010" "titulo" => "Methods" "secciones" => array:1 [ 0 => array:2 [ "identificador" => "sec0015" "titulo" => "Statistical analysis" ] ] ] 7 => array:2 [ "identificador" => "sec0020" "titulo" => "Results" ] 8 => array:2 [ "identificador" => "sec0025" "titulo" => "Discussion" ] 9 => array:2 [ "identificador" => "sec0030" "titulo" => "Funding" ] 10 => array:2 [ "identificador" => "sec0035" "titulo" => "Conflict of interests" ] 11 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2020-04-26" "fechaAceptado" => "2020-08-06" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec1383152" "palabras" => array:4 [ 0 => "Trauma patients" 1 => "Pelvic fracture" 2 => "FAST" 3 => "Accuracy" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec1383153" "palabras" => array:4 [ 0 => "Paciente politraumático" 1 => "Fractura de pelvis" 2 => "FAST" 3 => "Exactitud" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:3 [ "titulo" => "Abstract" "resumen" => "IntroductionFAST is essential to decide whether trauma patients need laparotomy, but it has a notable decrease in accuracy in patients with pelvic fracture.Our objective is to analyze the consequences of therapeutic decision-making based on the FAST results in trauma patients with pelvic fracture. MethodsDescriptive study that includes trauma patients older than 16 with a pelvic fracture admitted to the critical care area or who died. The FAST result was compared with a true positive or negative value according to the results of laparotomy or abdominal CT. We recorded diagnosis and treatment of each injury and resolution of the case, detailing the cause of death, among all variables. ResultsOver the 13-year period, we included 263 trauma patients with pelvic fracture, with a mean ISS of 31 and mortality of 19%. FAST had a sensitivity of 65.2%, specificity of 69%, false negative rate of 34.8% and false positive rate of 30.9%. Hemodynamically unstable patients died twice as many stable patients (27% vs 14%, P < .05). Patients with positive FAST died more than negative FAST (43% vs 26%); and 4 out of 10 hemodynamically unstable patients who underwent non-therapeutic laparotomy after presenting a false positive FAST died from hypovolemic shock. The mortality rate fell from 60% to 20% when preperitoneal packing was performed before angio-embolization of the pelvis. ConclusionFAST has low accuracy in polytraumatized patients with pelvic fracture. Patients with false positive FAST have higher mortality, which can be reduced notably by applying preperitoneal packing." "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0010" "titulo" => "Introduction" ] 1 => array:2 [ "identificador" => "abst0015" "titulo" => "Methods" ] 2 => array:2 [ "identificador" => "abst0020" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0025" "titulo" => "Conclusion" ] ] ] "es" => array:3 [ "titulo" => "Resumen" "resumen" => "IntroducciónLa exactitud del FAST disminuye notablemente en los pacientes politraumáticos con fractura pélvica.El objetivo es analizar las consecuencias de tomar decisiones terapéuticas basadas en el resultado del FAST en los pacientes politraumáticos con fractura de pelvis. MétodosEstudio descriptivo de pacientes con politraumatismos mayores de 16 años que han ingresado en el área de críticos o que han fallecido previamente, con fractura pélvica. El resultado del FAST ha sido comparado con un valor realmente positivo o negativo según el resultado de la laparotomía o de la tomografía computarizada. ResultadosEn 13 años, se ha incluido a 263 pacientes politraumáticos con fractura pélvica (ISS medio de 31; mortalidad 19%). El FAST tenía una sensibilidad del 65,2%, una especificidad del 69%, una tasa de falsos negativos del 34,8% y una tasa de falsos positivos del 30,9%. Los pacientes hemodinámicamente inestables tenían el doble de mortalidad que los pacientes estables (27% vs. 14%, p < 0,05). Los pacientes con un FAST positivo tenían mayor mortalidad que los pacientes con FAST negativo (43% vs. 26%); 4 de 10 pacientes hemodinámicamente inestables con un FAST falsamente positivo que se sometieron a laparotomía exploradora innecesaria murieron por shock hipovolémico. La mortalidad se redujo del 60 al 20% asociando un packing preperitoneal. ConclusionesLa reducida eficacia del FAST en pacientes con fractura de pelvis nos obliga a cuestionarnos las consecuencias de la toma de decisiones terapéuticas con base en sus resultados. Los pacientes con FAST falsamente positivo tienen una mortalidad mayor, que se puede reducir aplicando un packing preperitoneal." "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0030" "titulo" => "Introducción" ] 1 => array:2 [ "identificador" => "abst0035" "titulo" => "Métodos" ] 2 => array:2 [ "identificador" => "abst0040" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0045" "titulo" => "Conclusiones" ] ] ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "Please cite this article as: Montmany Vioque S, Rebasa Cladera P. Campos Serra A, Gràcia Roman R, Luna Aufroy A, Navarro Soto S. Consecuencias de la toma de decisiones terapéuticas con base en el resultado del FAST en pacientes politraumáticos con fractura pélvica. Cir Esp. 2021;99:433–439." ] ] "multimedia" => array:6 [ 0 => array:8 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1873 "Ancho" => 2168 "Tamanyo" => 231944 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Fig. " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "STARD diagram." ] ] 1 => array:8 [ "identificador" => "fig0010" "etiqueta" => "Fig. 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1840 "Ancho" => 2115 "Tamanyo" => 104820 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0010" "detalle" => "Fig. " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "Use of FAST." ] ] 2 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0015" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "SD: standard deviation; ISS: Injury Severity Score." "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Patients with multiple trauma N = 1826 \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Polytrauma patients with pelvic fracture N = 263 \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">P \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " colspan="4" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Age</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " colspan="4" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Sex</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">48 yrs (SD 19 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">49 yrs (SD 20) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">NA \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Males \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">75.5% (N = 1379) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">67% (N = 176) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.004 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Females \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">24.5% (N = 447) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">33% (N = 87) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " colspan="4" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Mechanism of action</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Traffic accident \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">41.2% (N = 752) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">39.9% (N = 105) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">< 0.001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Fall \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">35.4% (N = 647) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">36.5% (N = 96) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Hit/run over by vehicle \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">8.9% (N = 162) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">17.5% (N = 46) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Other, blunt \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">8.2% (N = 150) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4.9% (N = 13) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Penetrating \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">6.3% (N = 115) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1.1% (N = 3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " colspan="4" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">ISS1</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">19 (SD 14) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">31 (SD 16) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><0.001 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Mortality \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">10.8% (N = 198) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">19% (N = 50) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><0.001 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " colspan="4" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Cause of death</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Neurological \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">52% (N = 103) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">30% (N = 15) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.009 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Hypovolemic shock \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">23.7% (N = 47) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">48% (N = 24) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Respiratory \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">11.6% (N = 23) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">8% (N = 4) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Multiple organ failure \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">9.6% (N = 19) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">14% (N = 7) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Cardiac \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3% (N = 6) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab2622044.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Demographic data." ] ] 3 => array:8 [ "identificador" => "tbl0010" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0020" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">FAST – \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">FAST + \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Total \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">True + \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">15 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">23 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">True – \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">38 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">17 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">55 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Total \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">46 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">32 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">78 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab2622045.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Results of FAST." ] ] 4 => array:8 [ "identificador" => "tbl0015" "etiqueta" => "Table 3" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0025" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "FP: false positive; TP: true positive." "tablatextoimagen" => array:4 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Total \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Death \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">P \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Hemodynamically stable \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">144 patients \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">14% (N = 20) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.01 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Hemodynamically unstable \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">119 patients \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">27% (N = 30) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab2622041.png" ] ] 1 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Total \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Death \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Hemodynamically unstable with negative FAST \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">46 patients \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">26% (N = 12) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Hemodynamically unstable with positive FAST \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">28 patients \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">43% (N = 12) \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab2622046.png" ] ] 2 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Total \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Death \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Hemodynamically unstable with TP FAST \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">15 patients \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">40% (N = 6) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Hemodynamically unstable with FP FAST \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">17 patients \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">41% (N = 7) \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab2622042.png" ] ] 3 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Total \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Death \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Unnecessary laparotomy (FP) with preperitoneal packing \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">5 patients \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">20% (N = 1) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Unnecessary laparotomy (FP) without preperitoneal packing \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">5 patients \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">60% (N = 3) \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab2622043.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Differences in mortality." ] ] 5 => array:5 [ "identificador" => "fig0015" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => false "mostrarDisplay" => true "figura" => array:1 [ 0 => array:4 [ "imagen" => "fx1.jpeg" "Alto" => 518 "Ancho" => 1333 "Tamanyo" => 99033 ] ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:21 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The injury severity score: a method for describing patients with multiple injuries and evaluating emergency care" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "S.P. Baker" 1 => "B. O’Neill" 2 => "W. Haddon Jr" 3 => "B.L. William" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "J Trauma." "fecha" => "1974" "volumen" => "14" "paginaInicial" => "187" "paginaFinal" => "196" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/4814394" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The Focused Assessment with Sonography for Trauma (FAST) Examination and pelvic trauma: indications and limitations" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "N.M. Shaukat" 1 => "N. Copeli" 2 => "P. Desai" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Emerg Med Practice" "fecha" => "2016" "volumen" => "18" "paginaInicial" => "1" "paginaFinal" => "20" ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0015" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Pelvic fracture: the last 50 years" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "L. Flint" 1 => "H. Cryer" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/TA.0b013e3181ef9ce1" "Revista" => array:6 [ "tituloSerie" => "J Trauma." "fecha" => "2010" "volumen" => "69" "paginaInicial" => "483" "paginaFinal" => "488" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20838117" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0020" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Haemodynamically unstable pelvic fractures" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "C.E. White" 1 => "J.R. Hsu" 2 => "J.B. Holcomb" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.injury.2008.11.023" "Revista" => array:6 [ "tituloSerie" => "Injury." "fecha" => "2009" "volumen" => "40" "paginaInicial" => "1023" "paginaFinal" => "1030" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19371871" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0025" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Focused abdominal sonography in trauma" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "S.S. Lingawi" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "J HK Coll Radiol." "fecha" => "2001" "volumen" => "4" "paginaInicial" => "222" "paginaFinal" => "225" ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0030" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Focused assessment with sonography for trauma" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "S.G. James" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Atlas Oral Maxillofacial Surg Clin N Am." "fecha" => "2015" "volumen" => "23" "paginaInicial" => "131" "paginaFinal" => "136" "itemHostRev" => array:3 [ "pii" => "S0735109701016175" "estado" => "S300" "issn" => "07351097" ] ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0035" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "Advanced Trauma Life Support (ATLS), 10th ed., 2018. American College of Trauma." ] ] ] 7 => array:3 [ "identificador" => "bib0040" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Practice management guidelines for the evaluation of blunt abdominal trauma: the East practice management guidelines work group" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "W.S. Hoff" 1 => "M. Holevar" 2 => "K.K. Nagy" 3 => "L. Patterson" 4 => "J. Young" 5 => "A. Arrillaga" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/00005373-200209000-00038" "Revista" => array:6 [ "tituloSerie" => "J Trauma." "fecha" => "2002" "volumen" => "53" "paginaInicial" => "602" "paginaFinal" => "615" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12352507" "web" => "Medline" ] ] ] ] ] ] ] ] 8 => array:3 [ "identificador" => "bib0045" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The utility of FAST for initial abdominal screening of major pelvic fracture patients" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "D. Verbeek" 1 => "I. Zijlstra" 2 => "C. Leij" 3 => "K. Ponsen" 4 => "O. Delden" 5 => "J.C. Goslings" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s00268-013-2412-z" "Revista" => array:6 [ "tituloSerie" => "World J Surg." "fecha" => "2014" "volumen" => "38" "paginaInicial" => "1719" "paginaFinal" => "1725" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24381045" "web" => "Medline" ] ] ] ] ] ] ] ] 9 => array:3 [ "identificador" => "bib0050" "etiqueta" => "10" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Abdominal ultrasound is an unrealiable modality for the detection of hemoperitoneum in patients with pelvic fracture" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "R.S. Friese" 1 => "S. Malekzadeh" 2 => "S. Shafi" 3 => "L. Gentilello" 4 => "A. Starr" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/TA.0b013e31805f6ffb" "Revista" => array:6 [ "tituloSerie" => "J Trauma." "fecha" => "2007" "volumen" => "63" "paginaInicial" => "97" "paginaFinal" => "102" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17622875" "web" => "Medline" ] ] ] ] ] ] ] ] 10 => array:3 [ "identificador" => "bib0055" "etiqueta" => "11" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Clinical predictors of injuries not identified by focused abdominal sonogram for trauma (FAST) examination" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "L. Hoffman" 1 => "D. Pierce" 2 => "S. Puumala" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.jemermed.2007.09.035" "Revista" => array:6 [ "tituloSerie" => "J Emerg Med." "fecha" => "2009" "volumen" => "36" "paginaInicial" => "271" "paginaFinal" => "279" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18375089" "web" => "Medline" ] ] ] ] ] ] ] ] 11 => array:3 [ "identificador" => "bib0060" "etiqueta" => "12" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "An algorithm to reduce the incidence of false-negative FAST examinations in patients at high risk for occult injury. Focused Assessment for the Sonographic Examination of the Trauma patient" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "R.B. Ballard" 1 => "G.S. Rozycki" 2 => "P.G. Newman" 3 => "J.E. Cubillos" 4 => "J.P. Salomone" 5 => "W.L. Ingram" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/s1072-7515(99)00121-0" "Revista" => array:6 [ "tituloSerie" => "J Am Coll Surg." "fecha" => "1999" "volumen" => "189" "paginaInicial" => "145" "paginaFinal" => "150" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10437835" "web" => "Medline" ] ] ] ] ] ] ] ] 12 => array:3 [ "identificador" => "bib0065" "etiqueta" => "13" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Abdominal injuries without hemoperitoneum: a potential limitation of focused abdominal sonography for trauma (FAST)" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "W.C. Chiu" 1 => "B.M. Cushing" 2 => "A. Rodriguez" 3 => "S.M. Ho" 4 => "S.E. Mirvis" 5 => "K. Shanmuganathan" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:4 [ "tituloSerie" => "J Trauma." "fecha" => "1997" "volumen" => "42" "itemHostRev" => array:3 [ "pii" => "S0735109712028963" "estado" => "S300" "issn" => "07351097" ] ] ] ] ] ] ] 13 => array:3 [ "identificador" => "bib0070" "etiqueta" => "14" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "A Revision of the trauma score" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "H.R. Champion" 1 => "W. Sacco" 2 => "W.S. Copes" 3 => "D.S. Gann" 4 => "T.A. Gennarelli" 5 => "M.E. Flanagan" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/00005373-198905000-00017" "Revista" => array:6 [ "tituloSerie" => "J Trauma." "fecha" => "1989" "volumen" => "29" "paginaInicial" => "623" "paginaFinal" => "629" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/2657085" "web" => "Medline" ] ] ] ] ] ] ] ] 14 => array:3 [ "identificador" => "bib0075" "etiqueta" => "15" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Pruebas diagnósticas: nociones básicas para su correcta interpretación y uso" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "J. Escrig-Sos" 1 => "D. Martínez-Ramos" 2 => "D. Miralles-Tena" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/s0009-739x(06)70871-5" "Revista" => array:6 [ "tituloSerie" => "Cir Esp." "fecha" => "2006" "volumen" => "79" "paginaInicial" => "267" "paginaFinal" => "273" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16753115" "web" => "Medline" ] ] ] ] ] ] ] ] 15 => array:3 [ "identificador" => "bib0080" "etiqueta" => "16" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Rentabilidad diagnóstica de la punción percutánea pancreática en función del tamaño de la lesión" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "C. Fortea-Sanchis" 1 => "L. Gómez-Quiles" 2 => "D. Martínez-Ramos" 3 => "J. Escrig" 4 => "G.A. Paiva-Coronel" 5 => "R. Queralt-Martín" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.ciresp.2012.10.019" "Revista" => array:6 [ "tituloSerie" => "Cir Esp." "fecha" => "2013" "volumen" => "91" "paginaInicial" => "361" "paginaFinal" => "365" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23414939" "web" => "Medline" ] ] ] ] ] ] ] ] 16 => array:3 [ "identificador" => "bib0085" "etiqueta" => "17" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "STARD 2015: An Updated list of essential items for reporting diagnostic accuray studies" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "P. Bossuyt" 1 => "J. Reitsma" 2 => "D. Bruns" 3 => "C. Gatsonis" 4 => "P. Glasziou" 5 => "L. Irwig" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1373/clinchem.2015.246280" "Revista" => array:6 [ "tituloSerie" => "Clin Chem." "fecha" => "2015" "volumen" => "61" "paginaInicial" => "1446" "paginaFinal" => "1452" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26510957" "web" => "Medline" ] ] ] ] ] ] ] ] 17 => array:3 [ "identificador" => "bib0090" "etiqueta" => "18" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Estudio para la mejoría de la atención hospitalaria inicial del paciente politraumatizado: proyecto TRAUMACAT" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "S. Navarro" 1 => "M. Koo" 2 => "C. Orrego" 3 => "J.M. Muñoz-Vives" 4 => "M. Rivero" 5 => "S. Montmany" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Med Clin (Barc)." 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"fecha" => "2018" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18073614" "web" => "Medline" ] ] ] ] ] ] ] ] 20 => array:3 [ "identificador" => "bib0105" "etiqueta" => "21" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Free abdominal fluid on ultrasound in unstable pelvic ring fracture: is laparotomy always necessary?" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:7 [ 0 => "S. Ruchholtz" 1 => "C. Waydhas" 2 => "U. Lewan" 3 => "B. Pehle" 4 => "G. Taeger" 5 => "C. Kühne" 6 => "D. Nast-Kolb" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/01.ta.0000133840.44265.ca" "Revista" => array:6 [ "tituloSerie" => "J Trauma." 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Consequencies of therapeutic decision-making based on FAST results in trauma patients with pelvic fracture

Consecuencias de la toma de decisiones terapéuticas con base en el resultado del FAST en pacientes politraumáticos con fractura pélvica

Sandra Montmany Vioque

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sandra.montmany@gmail.com

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, Pere Rebasa Cladera, Andrea Campos Serra, Raquel Gràcia Roman, Alexis Luna Aufroy, Salvador Navarro Soto

Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitari Parc Taulí, Sabadell, Barcelona, Spain

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    "titulo" => "Consequencies of therapeutic decision-making based on FAST results in trauma patients with pelvic fracture"
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Polytrauma patients with pelvic fracture are high-energy trauma patients&#46; These fractures are associated with a high risk of mortality that may even reach 45&#37;&#44; a mean injury severity score &#40;ISS&#41;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> of 50 and associated injuries in more than 90&#37; of cases&#46;<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2&#8211;4</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Hemodynamically unstable polytrauma patients with pelvic fracture require rapid and effective initial evaluation that allows for appropriate treatment to be initiated as soon as possible to achieve the best results&#46; Focused Abdominal Sonography for Trauma &#40;FAST&#41;<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">5&#44;6</span></a> is an essential non-invasive tool used for rapid evaluation of the abdomen in order to detect hemoperitoneum&#46; According to well-standardized studies and protocols&#44;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> the presence of hemoperitoneum is an indicator of intra-abdominal injury requiring immediate surgical intervention&#46; Meanwhile&#44; hemodynamically unstable patients with pelvic fracture and negative FAST require pelvic angioembolization or preperitoneal packing&#44; depending on the therapeutic possibilities&#46;<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">7&#44;8</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">FAST has a sensitivity &#62;87&#37; and a specificity &#62;92&#37; to detect the presence or absence of hemoperitoneum in polytrauma patients with hypovolemic shock&#46;<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">7&#44;8</span></a> These values &#8203;&#8203;decrease significantly when the trauma involves pelvic fracture because the false positive and false negative rates increase considerably&#46; In patients with pelvic fracture&#44; the FAST achieves a sensitivity that ranges between 26&#37; and 65&#37;&#44; and a specificity that ranges from 80&#37; to 90&#37;&#46;<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">9&#8211;13</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">The hypothesis of the study is that the low sensitivity and specificity of FAST in polytrauma patients with pelvic fracture leads to a greater number of unnecessary laparotomies and a delay in the angiographic treatment needed&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">The main objective of our study is to assess the validity of FAST in polytrauma patients with a pelvic fracture and to analyze the clinical consequences of therapeutic decision-making based on its results&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Methods</span><p id="par0030" class="elsevierStylePara elsevierViewall">We present a retrospective&#44; descriptive study of polytrauma patients with pelvic fracture over the age of 16 who were either admitted to the critical care unit or died&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">The patients were prospectively registered in a protected Access&#174; database from March 2006 until today&#46; The following variables were collected for each case&#58; age&#44; sex&#44; mechanism of action&#44; ISS 8&#44; Revised Trauma Score &#40;RTS&#41;&#44;<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">14</span></a> prehospital and hospital vital signs&#44; complementary tests performed&#44; diagnosis and treatment of each injury&#44; complications and resolution of the case&#44; specifying the date and cause of death if the patient has died&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">When FAST was used&#44;<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">5&#44;6</span></a> two possible results have been reported&#58; positive&#44; when free fluid was observed in the abdominal cavity&#59; or negative&#44; when free fluid was not observed in the abdominal cavity&#46; For the purpose of this study&#44; we did not perform pericardial FAST&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">A standard reference in surgical patients is the presence or absence of pathological findings&#46; For our study&#44; the presence of pathological findings was defined as a necessary laparotomy &#40;hemoperitoneum &#62;500&#160;cc and injuries requiring surgical treatment&#41;&#46; The absence of pathological findings was defined as an unnecessary laparotomy &#40;no pathological findings&#44; or minor injuries requiring no surgical treatment&#41;&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">The standard reference study in non-operated patients was computed tomography &#40;CT&#41; scan&#46; The presence of pathological findings was defined as CT findings requiring surgical treatment&#46; The absence of pathological findings was defined as either a normal CT scan or pathological findings on CT that required nonsurgical treatment&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">We compared the FAST results with the standard reference tests depending on whether the hemodynamically unstable patients &#40;systolic blood pressure &#8804;90 or heart rate &#8805;100&#41; underwent laparotomy&#46;</p><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Statistical analysis</span><p id="par0060" class="elsevierStylePara elsevierViewall">The descriptive analysis was presented as mean and standard deviation for continuous variables and as percentages for categorical variables&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">We calculated the sensitivity&#44; specificity&#44; positive predictive value and negative predictive value of the FAST&#46; There were no missing data&#46;<a class="elsevierStyleCrossRefs" href="#bib0075"><span class="elsevierStyleSup">15&#44;16</span></a></p><p id="par0070" class="elsevierStylePara elsevierViewall">We have followed the STARD<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">17</span></a> method for reporting the results&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">The Student&#8217;s <span class="elsevierStyleItalic">t</span> test and the chi-square test were used to compare groups after confirming the normality of the variables and the homoscedasticity of the variance&#46; For the analysis of numerical variables that did not comply with the laws of normality&#44; a non-parametric Mann&#8211;Whitney U test was used&#46; IBM SPSS 21&#46;0&#174; was used for the different statistical calculations&#46;</p></span></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Results</span><p id="par0080" class="elsevierStylePara elsevierViewall">In a 13-year period&#44; from March 2006 to March 2019&#44; we registered 1826 patients over the age of 16 with multiple injuries who were either admitted to the critical care unit or died&#44; 14&#46;4&#37; of which &#40;263 patients&#41; presented pelvic fracture&#46; Out of the 263 patients with pelvic fracture&#44; 78 hemodynamically unstable patients studied by FAST were included in our study &#40;see STARD diagram&#44; <a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0085" class="elsevierStylePara elsevierViewall">The mean age of the polytrauma patients with pelvic fracture was 49&#44; and 67&#37; of the patients were men&#46; The mechanism of action was mainly blunt trauma &#40;99&#37;&#41;&#44; and the most frequent causes were traffic accidents and falls &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0090" class="elsevierStylePara elsevierViewall">The mean ISS 1 was 31 &#40;SD 16&#41;&#44; which was clearly higher than the mean ISS for patients with multiple injuries registered in our hospital &#40;ISS 19&#44; SD 14&#41;&#46; Mortality was 19&#37;&#44; which was also higher than the mortality rate of the global series &#40;10&#46;8&#37;&#41;&#46; The main cause of death varied from neurological causes in the general group to hypovolemic shock when the patient presented pelvic fracture &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46;</p><p id="par0095" class="elsevierStylePara elsevierViewall">Out of the 263 polytrauma patients with pelvic fracture&#44; FAST was performed in 98 &#40;37&#37;&#41;&#58; 39 positive&#44; and 59 negative&#46;</p><p id="par0100" class="elsevierStylePara elsevierViewall">In our series&#44; 144 patients were hemodynamically stable&#44; and FAST was performed in 14&#37; &#40;20 patients&#41;&#44; despite their stability&#46; Out of the 119 hemodynamically unstable patients&#44; the FAST score was analyzed in 66&#37; &#40;78&#41;&#44; finding 46 patients with negative FAST &#40;39&#37;&#41; and 32 with positive FAST &#40;27&#37;&#41; &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#41;&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0105" class="elsevierStylePara elsevierViewall">When we analyzed the FAST result versus the actual presence or absence of intra-abdominal bleeding &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#41;&#44; we found a false negative rate of 34&#46;8&#37; and a false positive rate of 30&#46;9&#37;&#46; In our series&#44; the sensitivity of FAST was 65&#46;2&#37; &#40;95&#37; CI&#58; 45&#46;75 &#37;&#8211;84&#46;68 &#37;&#41;&#44; specificity 69&#37; &#40;95&#37; CI&#58; 56&#46;88 &#37;&#8211;81&#46;30 &#37;&#41;&#44; positive predictive value 46&#46;8&#37; &#40;95&#37; CI&#58; 29&#46;58 &#37;&#8211;64&#46;17 &#37;&#41; and negative predictive value 82&#46;6&#37; &#40;95&#37; CI&#58; 71&#46;66 &#37;&#8211;93&#46;56 &#37;&#41;&#46; 100&#37; of the FAST false negatives &#40;8 patients&#41; required surgical treatment that was delayed due to the performance of an abdominal CT scan in hemodynamically unstable patients&#46; Meanwhile&#44; 58&#46;8&#37; of the FAST false positives &#40;10 patients&#41; underwent an unnecessary laparotomy&#44; causing a delay in the needed angiographic treatment of the pelvic fracture&#44; with active arterial bleeding&#46; We had temporarily stabilized the pelvis of all patients undergoing laparotomy by means of a strap &#40;sheet&#44; belt&#44; or other device suitable for such use&#41;&#46; In no case was surgical external fixation used at this point of treatment&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0110" class="elsevierStylePara elsevierViewall">The analysis of the number of quadrants where free fluid was observed by FAST &#40;hepatorenal fossa&#44; splenorenal fossa and pelvis&#41; found no differences between true positives and false positives&#46; The mean number of quadrants with free fluid detected by FAST was 2 in the false positive cases and 2&#46;13 in the true positives&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">When we compared the mortality rate of the different groups of patients&#44; we observed that hemodynamically unstable patients had almost twice the mortality compared to stable patients &#40;27&#37; vs 14&#37;&#44; <span class="elsevierStyleItalic">P</span>&#160;&#60;&#160;&#46;05&#41;&#46; Hemodynamically unstable patients with a positive FAST died more frequently than patients with a negative FAST &#40;43&#37; vs 26&#37;&#41;&#46; Although the mortality rate in hemodynamically unstable patients was similar when the FAST was true positive or false positive &#40;40&#37; vs&#46; 41&#37;&#41;&#44; 4 out of 10 hemodynamically unstable patients who had undergone unnecessary laparotomy due to a false-positive FAST died from hypovolemic shock secondary to pelvic bleeding&#46; This mortality rate &#40;60&#37;&#41; dropped to 20&#37; when it was associated with preperitoneal packing before angioembolization of the pelvis &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Discussion</span><p id="par0120" class="elsevierStylePara elsevierViewall">It is already well known<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3&#44;4&#44;7</span></a> that polytrauma patients with pelvic fracture are a group of patients with greater injury severity &#40;mean ISS 31 vs&#46; 19&#44; <span class="elsevierStyleItalic">P</span>&#160;&#60;&#160;&#46;05&#41; and a higher percentage of mortality &#40;19&#37; vs 10&#46;8&#37;&#44; <span class="elsevierStyleItalic">P</span>&#160;&#60;&#160;&#46;05&#41; than patients with multiple trauma injuries in general&#46; The management of hemorrhage is essential in polytrauma patients with pelvic fracture since 48&#37; die due to hypovolemic shock&#46;</p><p id="par0125" class="elsevierStylePara elsevierViewall">In our study starting in 2006&#44; abdominal FAST was used to rule out bleeding in 65&#37; of cases&#46; Some 34&#37; of hemodynamically unstable patients endured the risk of transfer for abdominal CT scan without previously ruling out intra-abdominal bleeding using FAST&#46; This coincides with the results published in a multicenter study in Catalonia&#44; where 27&#37;&#8211;33&#37; of hemodynamically unstable patients were studied with abdominal CT scan&#46; This percentage did not decrease even after specific training information sessions and the placement of posters in the trauma rooms at different hospitals that provided treatment recommendations for patients with multiple trauma injuries&#46;<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">18</span></a></p><p id="par0130" class="elsevierStylePara elsevierViewall">Although the precision of FAST depends on the user&#44; its sensitivity in hemodynamically unstable patients with multiple trauma injuries ranges between 80&#37; and 97&#37;<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">5&#8211;8</span></a> and has an extraordinary specificity between 95&#37; and 99&#46;5&#37;&#46;<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">5&#8211;8</span></a> When hemodynamically unstable polytrauma patients have fractured pelvis&#44; there is a significant percentage of false positives and false negatives due to interference from the retroperitoneal hematoma associated with the pelvic fracture&#46; The high rate of false positives and false negatives reduces its sensitivity to values &#8203;&#8203;between 26&#37; and 65&#37;&#44; and its specificity to &#8203;&#8203;between 80&#37; and 90&#37;&#44;<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">9&#8211;13</span></a> despite the FAST being performed by examiners with the same experience that achieved a sensitivity and specificity &#62;80&#37;&#8211;90&#37; when there is no pelvic fracture&#46; In our hospital&#44; we have identified this significant reduction with a sensitivity of 65&#46;2&#37; and a specificity of 69&#37;&#44; even though the FAST is routinely conducted by radiologists with extensive experience in ultrasound&#46;</p><p id="par0135" class="elsevierStylePara elsevierViewall">In general&#44; 200&#160;mL of blood is needed to be able to visualize free fluid using FAST&#46;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a> It is scientifically proven that any amount of free fluid observed by FAST is an indication for laparotomy in hemodynamically unstable patients&#46;<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">5&#44;6&#44;10</span></a> The 4 spaces where the presence or absence of free fluid is classically studied with FAST are&#58; cardiac&#44; right flank &#40;hepatic&#47;renal&#41;&#44; left flank &#40;splenic&#47;renal&#41;&#44; and pelvis &#40;bladder&#47;rectal or uterine&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> In our study&#44; we analyzed whether the number of spaces where free fluid was observed by FAST was associated with a higher rate of false positives versus the rate of true positives&#46; No significant relationship was observed&#58; false positives were found &#8203;&#8203;with liquid in 3 quadrants&#44; and very positive values were found &#8203;&#8203;with liquid in a single quadrant&#46;</p><p id="par0140" class="elsevierStylePara elsevierViewall">As expected&#44; hemodynamically unstable patients die at nearly twice the rate of hemodynamically stable patients &#40;27&#37; vs 14&#37;&#44; <span class="elsevierStyleItalic">P</span>&#160;&#60;&#160;&#46;05&#41;&#46; More than half of polytrauma patients with pelvic fracture die due to hypovolemic shock &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#44; and more unstable patients with positive FAST die &#40;43&#37; vs 26&#37;&#41;&#44; which is probably associated with having least 2 sources of bleeding instead of one&#58; the pelvis and the abdomen&#46; Although mortality in hemodynamically unstable patients is similar when the FAST is true positive or false positive &#40;40&#37; vs 41&#37;&#41;&#44; when we performed an unnecessary laparotomy for a false positive FAST and associated preperitoneal packing before transferring the patient to the relevant destination &#40;angioembolization&#44; Intensive Care Unit&#44; etc&#46;&#41;&#44; mortality decreased from 60&#37; to 20&#37;&#46; In these patients&#44; where different and clinically relevant mortality percentages have been found&#44; it has not been possible to analyze their statistical value as the requirements necessary for the chi-square test were not met&#46;</p><p id="par0145" class="elsevierStylePara elsevierViewall">The limitation of the current study is the number of cases registered and included in the study&#44; which provides clinically very relevant results&#44; but the statistical significance would improve with a larger sample size&#46; The results can be extrapolated to any population of polytrauma patients with pelvic fracture and hemodynamic instability who undergo FAST&#46;</p><p id="par0150" class="elsevierStylePara elsevierViewall">It is not easy to find the origin of bleeding in patients with hypovolemic shock and a fractured pelvis&#46; The influence of the mechanism of action on the origin of the bleeding has been described&#44; and more than 80&#37; of patients with pelvic fracture due to a fall bleed from the pelvis itself&#44; while patients with a pelvic fracture caused by a crash-type mechanism may bleed from either the pelvis or abdomen&#46;<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">19</span></a></p><p id="par0155" class="elsevierStylePara elsevierViewall">The lower efficacy of FAST in patients with pelvic fracture forces us to question the consequences of making therapeutic decisions based on its results&#46; Patients with a false positive FAST have higher mortality rates&#44; and we must consider making changes in the treatment of these patients to lower these rates&#46;</p><p id="par0160" class="elsevierStylePara elsevierViewall">In addition to the mechanism of injury&#44; we should develop strategies to reduce the rate of false negatives and&#44; especially&#44; false positives in order to optimize appropriate treatment and reduce the mortality rate in hemodynamically unstable patients with polytrauma and pelvic fracture&#46; For this&#44; FAST can be repeated 15&#8722;20&#160;min later to compare both results&#46; With this maneuver&#44; the Christian et al&#46; group<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">20</span></a> has reduced the rate of false negatives to 2&#37;&#44; but they have found no differences in the rate of false positives&#46;</p><p id="par0165" class="elsevierStylePara elsevierViewall">When faced with a positive FAST&#44; Ruchholtz et al&#46;<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">21</span></a> always recommend laparotomy because they consider the risk of not performing a necessary laparotomy to be worse than performing unnecessary laparotomies&#46; In our study&#44; although mortality in hemodynamically unstable patients was similar when the FAST was true positive or false positive &#40;40&#37; vs 41&#37;&#41;&#44; 4 out of 10 hemodynamically unstable patients underwent unnecessary laparotomies for a false positive FAST and died from hypovolemic shock&#46; This mortality rate &#40;60&#37;&#41; was reduced to 20&#37; when it was associated with preperitoneal packing before moving the patient for angioembolization of the pelvis&#46; Another possibility to reduce mortality when given a positive FAST would be to compare the FAST result with a more invasive but more effective test&#44; such as a diagnostic peritoneal aspiration&#44; especially in patients who have suffered a crash-type mechanism of action&#44; with the intention of reducing the number of unnecessary laparotomies&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Funding</span><p id="par0170" class="elsevierStylePara elsevierViewall">The article has received no funding&#44; either public or private&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Conflict of interests</span><p id="par0175" class="elsevierStylePara elsevierViewall">The authors have no conflict of interests to declare&#46;</p></span></span>"
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          "titulo" => "Keywords"
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          "titulo" => "Resumen"
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          "titulo" => "Results"
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          "identificador" => "sec0035"
          "titulo" => "Conflict of interests"
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          "titulo" => "References"
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    "pdfFichero" => "main.pdf"
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    "fechaRecibido" => "2020-04-26"
    "fechaAceptado" => "2020-08-06"
    "PalabrasClave" => array:2 [
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        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Keywords"
          "identificador" => "xpalclavsec1383152"
          "palabras" => array:4 [
            0 => "Trauma patients"
            1 => "Pelvic fracture"
            2 => "FAST"
            3 => "Accuracy"
          ]
        ]
      ]
      "es" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Palabras clave"
          "identificador" => "xpalclavsec1383153"
          "palabras" => array:4 [
            0 => "Paciente politraum&#225;tico"
            1 => "Fractura de pelvis"
            2 => "FAST"
            3 => "Exactitud"
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    "resumen" => array:2 [
      "en" => array:3 [
        "titulo" => "Abstract"
        "resumen" => "<span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Introduction</span><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">FAST is essential to decide whether trauma patients need laparotomy&#44; but it has a notable decrease in accuracy in patients with pelvic fracture&#46;</p><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Our objective is to analyze the consequences of therapeutic decision-making based on the FAST results in trauma patients with pelvic fracture&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Methods</span><p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Descriptive study that includes trauma patients older than 16 with a pelvic fracture admitted to the critical care area or who died&#46; The FAST result was compared with a true positive or negative value according to the results of laparotomy or abdominal CT&#46; We recorded diagnosis and treatment of each injury and resolution of the case&#44; detailing the cause of death&#44; among all variables&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Results</span><p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Over the 13-year period&#44; we included 263 trauma patients with pelvic fracture&#44; with a mean ISS of 31 and mortality of 19&#37;&#46; FAST had a sensitivity of 65&#46;2&#37;&#44; specificity of 69&#37;&#44; false negative rate of 34&#46;8&#37; and false positive rate of 30&#46;9&#37;&#46; Hemodynamically unstable patients died twice as many stable patients &#40;27&#37; vs 14&#37;&#44; <span class="elsevierStyleItalic">P</span>&#160;&#60;&#160;&#46;05&#41;&#46; Patients with positive FAST died more than negative FAST &#40;43&#37; vs 26&#37;&#41;&#59; and 4 out of 10 hemodynamically unstable patients who underwent non-therapeutic laparotomy after presenting a false positive FAST died from hypovolemic shock&#46; The mortality rate fell from 60&#37; to 20&#37; when preperitoneal packing was performed before angio-embolization of the pelvis&#46;</p></span> <span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Conclusion</span><p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">FAST has low accuracy in polytraumatized patients with pelvic fracture&#46; Patients with false positive FAST have higher mortality&#44; which can be reduced notably by applying preperitoneal packing&#46;</p></span>"
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          0 => array:2 [
            "identificador" => "abst0010"
            "titulo" => "Introduction"
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            "titulo" => "Methods"
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            "titulo" => "Results"
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            "titulo" => "Conclusion"
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      "es" => array:3 [
        "titulo" => "Resumen"
        "resumen" => "<span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Introducci&#243;n</span><p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">La exactitud del FAST disminuye notablemente en los pacientes politraum&#225;ticos con fractura p&#233;lvica&#46;</p><p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">El objetivo es analizar las consecuencias de tomar decisiones terap&#233;uticas basadas en el resultado del FAST en los pacientes politraum&#225;ticos con fractura de pelvis&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">M&#233;todos</span><p id="spar0080" class="elsevierStyleSimplePara elsevierViewall">Estudio descriptivo de pacientes con politraumatismos mayores de 16 a&#241;os que han ingresado en el &#225;rea de cr&#237;ticos o que han fallecido previamente&#44; con fractura p&#233;lvica&#46; El resultado del FAST ha sido comparado con un valor realmente positivo o negativo seg&#250;n el resultado de la laparotom&#237;a o de la tomograf&#237;a computarizada&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Resultados</span><p id="spar0085" class="elsevierStyleSimplePara elsevierViewall">En 13 a&#241;os&#44; se ha incluido a 263 pacientes politraum&#225;ticos con fractura p&#233;lvica &#40;ISS medio de 31&#59; mortalidad 19&#37;&#41;&#46; El FAST ten&#237;a una sensibilidad del 65&#44;2&#37;&#44; una especificidad del 69&#37;&#44; una tasa de falsos negativos del 34&#44;8&#37; y una tasa de falsos positivos del 30&#44;9&#37;&#46; Los pacientes hemodin&#225;micamente inestables ten&#237;an el doble de mortalidad que los pacientes estables &#40;27&#37; vs&#46; 14&#37;&#44; p &#60;&#160;0&#44;05&#41;&#46; Los pacientes con un FAST positivo ten&#237;an mayor mortalidad que los pacientes con FAST negativo &#40;43&#37; vs&#46; 26&#37;&#41;&#59; 4 de 10 pacientes hemodin&#225;micamente inestables con un FAST falsamente positivo que se sometieron a laparotom&#237;a exploradora innecesaria murieron por shock hipovol&#233;mico&#46; La mortalidad se redujo del 60&#160;al 20&#37; asociando un packing preperitoneal&#46;</p></span> <span id="abst0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Conclusiones</span><p id="spar0090" class="elsevierStyleSimplePara elsevierViewall">La reducida eficacia del FAST en pacientes con fractura de pelvis nos obliga a cuestionarnos las consecuencias de la toma de decisiones terap&#233;uticas con base en sus resultados&#46; Los pacientes con FAST falsamente positivo tienen una mortalidad mayor&#44; que se puede reducir aplicando un packing preperitoneal&#46;</p></span>"
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        "etiqueta" => "&#9734;"
        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as&#58; Montmany Vioque S&#44; Rebasa Cladera P&#46; Campos Serra A&#44; Gr&#224;cia Roman R&#44; Luna Aufroy A&#44; Navarro Soto S&#46; Consecuencias de la toma de decisiones terap&#233;uticas con base en el resultado del FAST en pacientes politraum&#225;ticos con fractura p&#233;lvica&#46; Cir Esp&#46; 2021&#59;99&#58;433&#8211;439&#46;</p>"
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        "etiqueta" => "Fig&#46; 1"
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          "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">STARD diagram&#46;</p>"
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          "leyenda" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">SD&#58; standard deviation&#59; ISS&#58; Injury Severity Score&#46;</p>"
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                  <table border="0" frame="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Patients with multiple trauma N&#160;&#61;&#160;1826&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
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                  \t\t\t\t\ttable-head\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Age</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t ; entry_with_role_rowhead " colspan="4" align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Sex</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>48 yrs &#40;SD 19&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">49 yrs &#40;SD 20&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">NA&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Males&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">75&#46;5&#37; &#40;N&#160;&#61;&#160;1379&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#46;004&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Females&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " colspan="4" align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Mechanism of action</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Traffic accident&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">41&#46;2&#37; &#40;N&#160;&#61;&#160;752&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">&#60;&#160;0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Fall&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">35&#46;4&#37; &#40;N&#160;&#61;&#160;647&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">36&#46;5&#37; &#40;N&#160;&#61;&#160;96&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Hit&#47;run over by vehicle&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Other&#44; blunt&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">8&#46;2&#37; &#40;N&#160;&#61;&#160;150&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&#46;9&#37; &#40;N&#160;&#61;&#160;13&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Penetrating&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6&#46;3&#37; &#40;N&#160;&#61;&#160;115&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;1&#37; &#40;N&#160;&#61;&#160;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">ISS1</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>19 &#40;SD 14&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">31 &#40;SD 16&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Mortality</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>10&#46;8&#37; &#40;N&#160;&#61;&#160;198&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">19&#37; &#40;N&#160;&#61;&#160;50&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Cause of death</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Neurological&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">52&#37; &#40;N&#160;&#61;&#160;103&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">30&#37; &#40;N&#160;&#61;&#160;15&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;009&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Hypovolemic shock&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">23&#46;7&#37; &#40;N&#160;&#61;&#160;47&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">48&#37; &#40;N&#160;&#61;&#160;24&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Respiratory&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">11&#46;6&#37; &#40;N&#160;&#61;&#160;23&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8&#37; &#40;N&#160;&#61;&#160;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Multiple organ failure&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9&#46;6&#37; &#40;N&#160;&#61;&#160;19&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">14&#37; &#40;N&#160;&#61;&#160;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Cardiac&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#37; &#40;N&#160;&#61;&#160;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">FAST &#8211;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">FAST&#160;&#43;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Total&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">True &#43;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">15&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">23&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">True &#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">38&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">17&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">55&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Total&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">46&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">32&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">78&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
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                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Total&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Death&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Hemodynamically stable&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">144 patients&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">14&#37; &#40;N&#160;&#61;&#160;20&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;01&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Hemodynamically unstable&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">119 patients&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">27&#37; &#40;N&#160;&#61;&#160;30&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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            1 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="center" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Death&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Hemodynamically unstable with negative FAST&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">46 patients&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">26&#37; &#40;N&#160;&#61;&#160;12&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Hemodynamically unstable with positive FAST&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">28 patients&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">43&#37; &#40;N&#160;&#61;&#160;12&#41;&nbsp;\t\t\t\t\t\t\n
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                  <table border="0" frame="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">17 patients&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">Unnecessary laparotomy &#40;FP&#41; without preperitoneal packing&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">5 patients&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">60&#37; &#40;N&#160;&#61;&#160;3&#41;&nbsp;\t\t\t\t\t\t\n
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                          ]
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              "identificador" => "bib0050"
              "etiqueta" => "10"
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                    0 => array:2 [
                      "titulo" => "Abdominal ultrasound is an unrealiable modality for the detection of hemoperitoneum in patients with pelvic fracture"
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                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "R&#46;S&#46; Friese"
                            1 => "S&#46; Malekzadeh"
                            2 => "S&#46; Shafi"
                            3 => "L&#46; Gentilello"
                            4 => "A&#46; Starr"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1097/TA.0b013e31805f6ffb"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Trauma&#46;"
                        "fecha" => "2007"
                        "volumen" => "63"
                        "paginaInicial" => "97"
                        "paginaFinal" => "102"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17622875"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            10 => array:3 [
              "identificador" => "bib0055"
              "etiqueta" => "11"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Clinical predictors of injuries not identified by focused abdominal sonogram for trauma &#40;FAST&#41; examination"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "L&#46; Hoffman"
                            1 => "D&#46; Pierce"
                            2 => "S&#46; Puumala"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.jemermed.2007.09.035"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Emerg Med&#46;"
                        "fecha" => "2009"
                        "volumen" => "36"
                        "paginaInicial" => "271"
                        "paginaFinal" => "279"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18375089"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            11 => array:3 [
              "identificador" => "bib0060"
              "etiqueta" => "12"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "An algorithm to reduce the incidence of false-negative FAST examinations in patients at high risk for occult injury&#46; Focused Assessment for the Sonographic Examination of the Trauma patient"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "R&#46;B&#46; Ballard"
                            1 => "G&#46;S&#46; Rozycki"
                            2 => "P&#46;G&#46; Newman"
                            3 => "J&#46;E&#46; Cubillos"
                            4 => "J&#46;P&#46; Salomone"
                            5 => "W&#46;L&#46; Ingram"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/s1072-7515(99)00121-0"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Am Coll Surg&#46;"
                        "fecha" => "1999"
                        "volumen" => "189"
                        "paginaInicial" => "145"
                        "paginaFinal" => "150"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10437835"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            12 => array:3 [
              "identificador" => "bib0065"
              "etiqueta" => "13"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Abdominal injuries without hemoperitoneum&#58; a potential limitation of focused abdominal sonography for trauma &#40;FAST&#41;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "W&#46;C&#46; Chiu"
                            1 => "B&#46;M&#46; Cushing"
                            2 => "A&#46; Rodriguez"
                            3 => "S&#46;M&#46; Ho"
                            4 => "S&#46;E&#46; Mirvis"
                            5 => "K&#46; Shanmuganathan"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:4 [
                        "tituloSerie" => "J Trauma&#46;"
                        "fecha" => "1997"
                        "volumen" => "42"
                        "itemHostRev" => array:3 [
                          "pii" => "S0735109712028963"
                          "estado" => "S300"
                          "issn" => "07351097"
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                  ]
                ]
              ]
            ]
            13 => array:3 [
              "identificador" => "bib0070"
              "etiqueta" => "14"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "A Revision of the trauma score"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "H&#46;R&#46; Champion"
                            1 => "W&#46; Sacco"
                            2 => "W&#46;S&#46; Copes"
                            3 => "D&#46;S&#46; Gann"
                            4 => "T&#46;A&#46; Gennarelli"
                            5 => "M&#46;E&#46; Flanagan"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1097/00005373-198905000-00017"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Trauma&#46;"
                        "fecha" => "1989"
                        "volumen" => "29"
                        "paginaInicial" => "623"
                        "paginaFinal" => "629"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/2657085"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            14 => array:3 [
              "identificador" => "bib0075"
              "etiqueta" => "15"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Pruebas diagn&#243;sticas&#58; nociones b&#225;sicas para su correcta interpretaci&#243;n y uso"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "J&#46; Escrig-Sos"
                            1 => "D&#46; Mart&#237;nez-Ramos"
                            2 => "D&#46; Miralles-Tena"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/s0009-739x(06)70871-5"
                      "Revista" => array:6 [
                        "tituloSerie" => "Cir Esp&#46;"
                        "fecha" => "2006"
                        "volumen" => "79"
                        "paginaInicial" => "267"
                        "paginaFinal" => "273"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16753115"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            15 => array:3 [
              "identificador" => "bib0080"
              "etiqueta" => "16"
              "referencia" => array:1 [
                0 => array:2 [
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                    0 => array:2 [
                      "titulo" => "Rentabilidad diagn&#243;stica de la punci&#243;n percut&#225;nea pancre&#225;tica en funci&#243;n del tama&#241;o de la lesi&#243;n"
                      "autores" => array:1 [
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                            1 => "L&#46; G&#243;mez-Quiles"
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                            3 => "J&#46; Escrig"
                            4 => "G&#46;A&#46; Paiva-Coronel"
                            5 => "R&#46; Queralt-Mart&#237;n"
                          ]
                        ]
                      ]
                    ]
                  ]
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                        "tituloSerie" => "Cir Esp&#46;"
                        "fecha" => "2013"
                        "volumen" => "91"
                        "paginaInicial" => "361"
                        "paginaFinal" => "365"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23414939"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
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              "identificador" => "bib0085"
              "etiqueta" => "17"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "STARD 2015&#58; An Updated list of essential items for reporting diagnostic accuray studies"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "P&#46; Bossuyt"
                            1 => "J&#46; Reitsma"
                            2 => "D&#46; Bruns"
                            3 => "C&#46; Gatsonis"
                            4 => "P&#46; Glasziou"
                            5 => "L&#46; Irwig"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1373/clinchem.2015.246280"
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                        "tituloSerie" => "Clin Chem&#46;"
                        "fecha" => "2015"
                        "volumen" => "61"
                        "paginaInicial" => "1446"
                        "paginaFinal" => "1452"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26510957"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            17 => array:3 [
              "identificador" => "bib0090"
              "etiqueta" => "18"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Estudio para la mejor&#237;a de la atenci&#243;n hospitalaria inicial del paciente politraumatizado&#58; proyecto TRAUMACAT"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "S&#46; Navarro"
                            1 => "M&#46; Koo"
                            2 => "C&#46; Orrego"
                            3 => "J&#46;M&#46; Mu&#241;oz-Vives"
                            4 => "M&#46; Rivero"
                            5 => "S&#46; Montmany"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Med Clin &#40;Barc&#41;&#46;"
                        "fecha" => "2014"
                        "volumen" => "143 Supl 1"
                        "paginaInicial" => "25"
                        "paginaFinal" => "31"
                        "itemHostRev" => array:3 [
                          "pii" => "S0735109706031184"
                          "estado" => "S300"
                          "issn" => "07351097"
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                  ]
                ]
              ]
            ]
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              "etiqueta" => "19"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Origen de la hemorragia en pacientes politraumatizados con fractura de pelvis e inestabilidad hemodin&#225;mica"
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                        0 => array:2 [
                          "etal" => false
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                            0 => "S&#46; Montmany"
                            1 => "P&#46; Rebasa"
                            2 => "A&#46; Luna"
                            3 => "J&#46;M&#46; Hidalgo"
                            4 => "G&#46; C&#225;novas"
                            5 => "S&#46; Navarro"
                          ]
                        ]
                      ]
                    ]
                  ]
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                    0 => array:2 [
                      "doi" => "10.1016/j.ciresp.2015.01.011"
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                        "tituloSerie" => "Cir Esp&#46;"
                        "fecha" => "2015"
                        "volumen" => "93"
                        "paginaInicial" => "450"
                        "paginaFinal" => "454"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25804517"
                            "web" => "Medline"
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                      ]
                    ]
                  ]
                ]
              ]
            ]
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              "identificador" => "bib0100"
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              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The FAST exam can reliably identify patients with significant intraabdominal hemorrhage in life threatening pelvic fractures"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
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                            1 => "C&#46;C&#46; Burlew"
                            2 => "E&#46;E&#46; Moore"
                            3 => "A&#46;E&#46; Geddes"
                            4 => "A&#46;E&#46; Wagenaar"
                            5 => "C&#46;J&#46; Fox"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
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                      "doi" => "10.1097/TA.0000000000001838"
                      "Revista" => array:3 [
                        "tituloSerie" => "J Trauma&#46;"
                        "fecha" => "2018"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18073614"
                            "web" => "Medline"
                          ]
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                      ]
                    ]
                  ]
                ]
              ]
            ]
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              "identificador" => "bib0105"
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                    0 => array:2 [
                      "titulo" => "Free abdominal fluid on ultrasound in unstable pelvic ring fracture&#58; is laparotomy always necessary&#63;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:7 [
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                            1 => "C&#46; Waydhas"
                            2 => "U&#46; Lewan"
                            3 => "B&#46; Pehle"
                            4 => "G&#46; Taeger"
                            5 => "C&#46; K&#252;hne"
                            6 => "D&#46; Nast-Kolb"
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                        ]
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                    ]
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                        "tituloSerie" => "J Trauma&#46;"
                        "fecha" => "2004"
                        "volumen" => "57"
                        "paginaInicial" => "278"
                        "paginaFinal" => "286"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15345973"
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Article information

ISSN: 21735077
Original language: English

DOI:10.1016/j.cireng.2021.05.007

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2024 August	50	4	54
2024 July	26	4	30
2024 June	28	2	30
2024 May	18	2	20
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2024 March	39	5	44
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2024 January	21	2	23
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2023 August	15	0	15
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2023 June	12	0	12
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2023 March	16	4	20
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