Focused abdominal sonogram for trauma: the learning curve of nonradiologist clinicians in detecting hemoperitoneum.
BACKGROUND
The focused abdominal sonogram for trauma (FAST) has been used by surgeons and emergency physicians (CLIN) to screen reliably for hemoperitoneum after trauma. Despite recommendations for "appropriate training," ranging from 50 to 400 proctored examinations, there are no supporting data.


METHODS
We prospectively examined the initial FAST experience of CLIN in detecting hemoperitoneum by using diagnostic peritoneal lavage, computed tomography, and clinical findings as the diagnostic "gold standard."


RESULTS
241 patients had FAST performed by 12 CLIN (average, 20/CLIN; range, 2-43); 51 patients (21.2%) had hemoperitoneum and 17 patients (7.1%) required laparotomy. Initial experience with FAST by CLIN produced 35 true positives, 180 true negatives, 16 false negatives, and 3 false positives; sensitivity, 68%; specificity, 98%. Initial error rate was 17%, which fell to 5% after 10 examinations (chi2; p < 0.05).


CONCLUSIONS
Previous recommendations for the number of proctored examinations for individual nonradiologist clinician sonographers to develop competence are excessive.
Shackford
S R
SR
University of Vermont, Department of Surgery, Burlington 05401, USA. sshackfo@salus.med.uvm.edu
Rogers
F B
FB
Osler
T M
TM
Trabulsy
M E
ME
Clauss
D W
DW
Vane
D W
DW
D000007:Abdominal Injuries / Q000175:diagnosis / Q000000981:diagnostic imaging*; D000328:Adult; D003951:Diagnostic Errors / Q000706:statistics & numerical data; D004635:Emergency Medicine / Q000193:education; D005260:Female; D006465:Hemoperitoneum / Q000000981:diagnostic imaging*; D006801:Humans; D015601:Injury Severity Score; D007858:Learning; D008297:Male; D010533:Peritoneal Lavage; D011446:Prospective Studies; D011871:Radiology / Q000193:education*; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed; D014463:Ultrasonography / Q000592:standards*; D014707:Vermont; D014949:Wounds, Nonpenetrating / Q000145:classification / Q000000981:diagnostic imaging*