title: The role of positive examinations in training for the focused assessment sonogram in trauma (FAST) examination.
abstract: The purpose of this study is to determine whether the inclusion of known positive patients to the practical portion of a Focused Assessment Sonogram in Trauma (FAST) training course improves overall training and increases FAST accuracy. This is a prospective double-blind design. Original course participants (PRE) underwent a 2-hour didactic session and practicum with ten normal volunteers. Modified course participants (POST) additionally imaged five peritoneal dialysis (PD) patients to simulate positive examinations. The practitioners (six PRE and five POST) were compared as to their ability to detect and quantify intraperitoneal fluid (0-2000 cc) in nine PD patients during a double-blind prospective examination. Test results were reported as positive or negative. Positive results were further quantified by volume. Each practitioner performed ten examinations. Data for inexperienced clinicians are presented. Sensitivity for detecting < or = 750 cm3 was 45 per cent PRE and 87 per cent POST (P = 0.02). Accuracy in quantifying volume within 250 cm3 was 38 per cent PRE and 44 per cent POST (not significant). FAST accuracy for inexperienced sonographers--particularly in diagnosing smaller volumes--can be improved significantly by including positive studies in training. Exposure to positive FAST examinations during training improves the learning curve. With the growing dependency on FAST to accurately triage blunt abdominal trauma safe and effective FAST training should consist of didactic education and a practical portion that includes positive studies. When screened properly PD patients can be used effectively to demonstrate positive FAST studies.
authors.affiliation: Division of Traumatology and Surgical Critical Care, The University of Pennsylvania Medical Center, Philadelphia, Pennsylvania, USA.
authors.forename: Vicente H
authors.initials: VH
authors.lastname: Gracias
authors.forename: Heidi
authors.initials: H
authors.lastname: Frankel
authors.forename: Rajan
authors.initials: R
authors.lastname: Gupta
authors.forename: Patrick M
authors.initials: PM
authors.lastname: Reilly
authors.forename: Felipe
authors.initials: F
authors.lastname: Gracias
authors.forename: Wendy
authors.initials: W
authors.lastname: Klein
authors.forename: Harvey
authors.initials: H
authors.lastname: Nisenbaum
authors.forename: C William
authors.initials: CW
authors.lastname: Schwab
mesh_terms: D000007:Abdominal Injuries / Q000000981:diagnostic imaging*; D002983:Clinical Competence; D004311:Double-Blind Method; D004502:Education, Medical, Continuing / Q000379:methods*; D006801:Humans; D010530:Peritoneal Dialysis; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D014194:Traumatology / Q000193:education*; D014463:Ultrasonography; D014949:Wounds, Nonpenetrating / Q000000981:diagnostic imaging*