The hand-held FAST: experience with hand-held trauma sonography in a level-I urban trauma center.
OBJECTIVE
To describe the effectiveness of a portable hand-held ultrasound machine when used by clinicians in the early evaluation and resuscitation of trauma victims.


METHODS
The study was a prospective evaluation in a level-I urban trauma center. The focussed assessment with sonography for trauma is a specifically defined examination for free fluid known as the focused assessment with sonography for trauma (FAST) exam. Seventy-one patients had a hand-held FAST (HHFAST) examination performed with a Sonosite 180, 2.4 kg ultrasound machine. Sixty-seven examinations were immediately repeated with a Toshiba SSH 140A portable floor-based machine. This repeat scan (formal FAST or FFAST) was used as a comparison standard between the devices for study purposes. Four patients had a HHFAST only, all with positive result, two being taken for immediate laparotomy, and two having a follow-up computed tomographic (CT) scan. Patient follow-up from other imaging studies, operative intervention, and clinical outcomes were also compared to the performance of each device.


RESULTS
There were 58 victims of blunt, and 13 of penetrating abdominal trauma. One examination was indeterminate using both machines. The apparent HHFAST performance yielded; sensitivity, specificity, positive predictive value, negative predictable value, and accuracy (S, S, PPV, NPV, A) of 83, 100, 100, 98, 98%. Upon review, a CT scan finding and benign clinical course found the HHFAST diagnosis to be correct rather than the FFAST in one case. Considering the ultimate clinical course of the patients, yielded a (S, S, PPV, NPV, A) of 78, 100, 100, 97, and 97% for the HHFAST and 75, 98, 86, 97, and 96% for the FFAST. Statistically, there was no significant difference in the actual performance of the HHFAST compared to the FFAST in this clinical setting.


CONCLUSIONS
Hand-held portable sonography can simplify early and accurate performance of FAST exams in victims of abdominal trauma.
Kirkpatrick
Andrew W
AW
Department of Surgery, Vancouver Hospital and Health Sciences Center, Trauma Services, 3rd Floor, 855 West 10th Avenue, Vancouver, BC, Canada V5Z 1L7. akirkpat@vanhosp.bc.ca
Simons
Richard K
RK
Brown
Ross
R
Nicolaou
Savvas
S
Dulchavsky
Scott
S
D000007:Abdominal Injuries / Q000000981:diagnostic imaging*; D001202:Ascitic Fluid / Q000000981:diagnostic imaging; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008824:Michigan; D019095:Point-of-Care Systems; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D014193:Trauma Centers; D014463:Ultrasonography; D014949:Wounds, Nonpenetrating / Q000000981:diagnostic imaging; D014950:Wounds, Penetrating / Q000000981:diagnostic imaging