title: Prospective evidence of the superiority of a sonography-based algorithm in the assessment of blunt abdominal injury.
abstract: BACKGROUND
  Although the routine use of FAST (focused assessment with sonography for trauma) in the evaluation of trauma victims is increasing, to our knowledge, a prospective comparison of contemporary adult trauma victims managed with and without FAST has not been reported in North America.
  
  
  METHODS
  Adult victims of blunt trauma for whom there was a suspicion of abdominal injury were managed with one of two diagnostic algorithms, FAST or no-FAST. The two algorithms were compared for diagnostic accuracy, cost, time, and delayed diagnoses.
  
  
  RESULTS
  Among 706 patients (mean Injury Severity Score, 23), 460 were managed with FAST and 246 with no-FAST. The two groups were similar with respect to age, Injury Severity Score, prehospital time, and mortality (p = not significant). There were 3 of 460 (0.7%) delayed diagnoses in the FAST group and 4 of 246 (1.6%) in the no-FAST group (p = not significant). The diagnostic accuracy for the FAST and no-FAST algorithms was 99% and 98%, respectfully. The FAST and no-FAST algorithms led to similar rates of laparotomy, 13% and 14%, respectfully, but nonoperative management was more common in the no-FAST group (p < 0.01). The mean diagnostic cost for the FAST algorithm was $156, compared with $540 with the no-FAST algorithm (p < 0.0001) and the mean time required for diagnostic work-up was 53 minutes with the FAST algorithm, compared with 151 minutes with the no-FAST algorithm (p < 0.0001).
  
  
  CONCLUSIONS
  This study has provided prospective evidence that a FAST-based algorithm for blunt abdominal injury was more rapid, less expensive, and as accurate as an algorithm that used computed tomography or diagnostic peritoneal lavage only. Trauma centers are encouraged to incorporate a FAST-based algorithm into their initial management of blunt trauma victims.
authors.affiliation: Department of Surgery, University of Kentucky Medical Center, Lexington 40536-0084, USA.
authors.forename: B R
authors.initials: BR
authors.lastname: Boulanger
authors.forename: B A
authors.initials: BA
authors.lastname: McLellan
authors.forename: F D
authors.initials: FD
authors.lastname: Brenneman
authors.forename: J
authors.initials: J
authors.lastname: Ochoa
authors.forename: A W
authors.initials: AW
authors.lastname: Kirkpatrick
mesh_terms: D000007:Abdominal Injuries / Q000000981:diagnostic imaging* / Q000401:mortality / Q000601:surgery; D000328:Adult; D000465:Algorithms; D003663:Decision Trees; D005260:Female; D017721:Hospital Costs / Q000706:statistics & numerical data; D006801:Humans; D015601:Injury Severity Score; D007813:Laparotomy / Q000706:statistics & numerical data; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D010533:Peritoneal Lavage / Q000191:economics / Q000592:standards; D011446:Prospective Studies; D015203:Reproducibility of Results; D013997:Time Factors; D014057:Tomography, X-Ray Computed / Q000191:economics / Q000592:standards; D014193:Trauma Centers; D014463:Ultrasonography; D014949:Wounds, Nonpenetrating / Q000000981:diagnostic imaging* / Q000401:mortality / Q000601:surgery