Validation of nurse-performed FAST ultrasound.
BACKGROUND
Patients presenting to Emergency Departments (EDs) with abdominal trauma benefit from FAST (Focused Assessment with Sonography in Trauma). Not all doctor members of the trauma team are credentialed in FAST; therefore occasionally no one is available in the hospital to undertake a FAST. Hence, the aim of this study was to determine the accuracy of nurse-performed FAST as a practical alternative where suitably trained doctors are not available.


METHODS
This was a prospective study of a convenience sample of patients with multisystem trauma in whom abdominal injury was clinically suspected. Senior nurses trained in FAST performed and reported FAST scans for each patient. Accuracy of nurse-performed FAST was determined by comparing results with computerised tomography (CT) scan or operation report.


RESULTS
242 indicated nurse-performed FAST scans were included in the study. Nurse-performed FAST demonstrated sensitivity of 84.4% (95% CI 72.1-92.2) and specificity of 98.4% (CI 94.9-99.6), a positive predictive value (PPV) of 94.2% (CI 83.1-98.5) and a negative predictive value (NPV) of 95.3% (91.0-97.7). Overall accuracy of nurse-performed FAST for the detection of free fluid was 95.0% (95% CI 91.3-97.3).


CONCLUSIONS
This study demonstrates that, in a convenience sample of injured patients, nurse-performed FAST achieved similar accuracy to previously published results of doctor-performed FAST. Future studies with greater patient numbers would be valuable.
Department of Emergency Medicine, Liverpool Hospital, Sydney, NSW 2170, Australia. justin.bowra@sah.org.au
Justin
J
Bowra
Sally
S
Forrest-Horder
Erica
E
Caldwell
Michelle
M
Cox
Scott K
SK
D'Amours
D000007:Abdominal Injuries / Q000000981:diagnostic imaging*; D000068:Accreditation / Q000379:methods*; D001202:Ascitic Fluid / Q000000981:diagnostic imaging; D004635:Emergency Medicine / Q000193:education; D016529:Emergency Nursing / Q000592:standards*; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D008297:Male; D009104:Multiple Trauma / Q000000981:diagnostic imaging*; D024802:Nurse's Role; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D014463:Ultrasonography; D000078329:Workforce