Prospective evaluation of hand-held focused abdominal sonography for trauma (FAST) in blunt abdominal trauma.
BACKGROUND
Ultrasonography (US) has become indispensable in assessing the status of the injured patient. Although hand-held US equipment is now commercially available and may expand the availability and speed of US in assessing the trauma patient, it has not been subjected to controlled evaluation in early trauma care.


METHODS
A 2.4-kg hand-held (HH) US device was used to perform focused abdominal sonography for trauma (FAST) on blunt trauma victims at 2 centres. Results were compared with the "truth" as determined through formal FAST examinations (FFAST), CT, operative findings and serial examination. The ability of HHFAST to detect free fluid, intra-abdominal injuries and injuries requiring therapeutic interventions was assessed.


RESULTS
HHFAST was positive in 80% of 313 patients who needed surgery or angiography. HHFAST test performances (sensitivity, specificity, positive and negative predictive values, likelihood ratios of positive and negative test results) were 77%, 99%, 96%, 94%, 95%, 95 and 0.2, respectively, for free fluid, and 64%, 99%, 96%, 89%, 90%, 74 and 0.4, respectively, for documented injuries. HHFAST missed or gave an indeterminate result in 8 (3%) of 270 patients with injuries who required therapeutic intervention and 25 (9%) of 270 patients who did not require intervention. FFAST performance was comparable.


CONCLUSIONS
HHFAST performed by clinicians detects intraperitoneal fluid with a high degree of accuracy. All FAST examinations are valuable tests when positive. They will miss some injuries, but the majority of the injuries missed do not require therapy. HHFAST provides an early extension of the physical examination but should be complemented by the selective use of CT, rather than formal repeat US.
Kirkpatrick
Andrew W
AW
Department of Critical Care Medicine, Foothills Medical Centre, Calgary, Alberta. andrew.kirckpatrick@calgaryhealthregion.ca
Sirois
Marco
M
Laupland
Kevin B
KB
Goldstein
Leanelle
L
Brown
David Ross
DR
Simons
Richard K
RK
Dulchavsky
Scott
S
Boulanger
Bernard R
BR
D000007:Abdominal Injuries / Q000000981:diagnostic imaging* / Q000503:physiopathology; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001202:Ascitic Fluid / Q000000981:diagnostic imaging; D015331:Cohort Studies; D005188:False Negative Reactions; D005189:False Positive Reactions; D005260:Female; D006801:Humans; D015601:Injury Severity Score; D008297:Male; D008875:Middle Aged; D019095:Point-of-Care Systems; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D014193:Trauma Centers; D018608:Ultrasonography, Doppler / Q000379:methods*; D014949:Wounds, Nonpenetrating / Q000000981:diagnostic imaging* / Q000503:physiopathology