Defining the learning curve for the Focused Abdominal Sonogram for Trauma (FAST) examination: implications for credentialing.
Focused Abdominal Sonogram for Trauma (FAST) examination is being used increasingly for the torso evaluation of injured patients. In a controlled setting using peritoneal dialysis patients as models for injured patients with free fluid we hypothesized that more experienced providers would perform FAST with greater accuracy. Twelve fellow or attending level trauma surgeons, two radiologists, and one ultrasound technician were studied for their ability to detect intraperitoneal fluid (0-1600 cm3) in nine peritoneal dialysis patients with two different volumes of dialysate/patient. FAST experience with injured patients was defined as minimal (<30 patients examinations), moderate (30-100), or extensive (>100). All surgeons had participated in a didactic/practical course before the study. Test results were reported as "+" or "-" by the participant; "+" results were further quantified by volume. The sensitivity of those in the minimal-, moderate-, and extensive-experience to detect <1 L was 45, 87, and 100 per cent, respectively; the accuracy in detecting dialysate volume within 250 cm3 was 38, 63, and 90 per cent, respectively. In this controlled setting the accuracy of FAST particularly in diagnosing smaller volumes, as well as the ability to quantify volume, improves with experience. The learning curve for FAST starts to flatten out at 30 to 100 examinations. Training and credentialing policies should consider these findings to optimize patient care.
Gracias
V H
VH
Division of Traumatology and Surgical Critical Care, The University of Pennsylvania Medical Center, Philadelphia, USA.
Frankel
H L
HL
Gupta
R
R
Malcynski
J
J
Gandhi
R
R
Collazzo
L
L
Nisenbaum
H
H
Schwab
C W
CW
D000007:Abdominal Injuries / Q000150:complications*; D002983:Clinical Competence / Q000592:standards*; D003406:Credentialing / Q000458:organization & administration*; D004311:Double-Blind Method; D004502:Education, Medical, Continuing / Q000458:organization & administration*; D006465:Hemoperitoneum / Q000000981:diagnostic imaging* / Q000209:etiology*; D006801:Humans; D007318:Inservice Training / Q000458:organization & administration*; D007858:Learning; D008505:Medical Staff, Hospital / Q000193:education*; D020380:Needs Assessment; D010530:Peritoneal Dialysis; D011446:Prospective Studies; D011871:Radiology / Q000193:education*; D012680:Sensitivity and Specificity; D013997:Time Factors; D014194:Traumatology / Q000193:education*; D014463:Ultrasonography / Q000379:methods* / Q000592:standards*