What is the utility of the Focused Assessment with Sonography in Trauma (FAST) exam in penetrating torso trauma?
OBJECTIVE
A recent Cochrane Review has demonstrated that emergency ultrasonography decreases the amount of computerised tomographic scans in blunt abdominal trauma.13 However, there is no systematic review that has evaluated the utility of the Focused Assessment with Sonography for Trauma(FAST) exam in penetrating torso trauma. We systematically reviewed the medical literature for the utility of the FAST exam to detect free intraperitoneal blood after penetrating torso trauma.


METHODS
We searched PUBMED and EMBASE databases for randomised controlled trials from 1965 through December 2009 using a search strategy derived from the following PICO formulation of our clinical question:


METHODS
patients (12+ years) sustaining penetrating trauma to the torso.


METHODS
FAST exam during their initial trauma workup. Comparator: either local wound exploration (LWE),computerised tomography (CT), diagnostic peritoneal lavage (DPL), or laparotomy.


RESULTS
intraperitoneal and pericardial free fluid. The methodological quality of the studies was assessed.Qualitative methods were used to summarise the study results.


METHODS
Sensitivities and specificities were compared using a Forest Plot (95% CI) calculated by Revman 5 (Review Manager Version 5.0. Copenhagen: The Nordic Cochrane Centre, The Cochrane Collaboration,2008) between the FAST exam and definitive diagnostic modalities such as LWE, CT, DPL, or laporotomy.


RESULTS
We identified eight observational studies (n=565 patients) that met our selection criteria. The prevalence of a positive FAST exam after penetrating trauma was fairly low ranging from 24.2% to 56.3%.The FAST exam for penetrating trauma is a highly specific (94.1–100.0%), but not very sensitive (28.1–100%) diagnostic modality.


CONCLUSIONS
From the review of the literature, a positive FAST exam has a high incidence of intraabdominal injury and should prompt an exploratory laparotomy. However, a negative initial FAST exam after penetrating trauma should prompt further diagnostic studies such as LWE, CT, DPL, or laparotomy.
Quinn
Antonia C
AC
Department of Emergency Medicine, SUNY-Downstate Medical Center, Brooklyn, NY 11203, United States. antonia424@earthlink.net
Sinert
Richard
R
D000007:Abdominal Injuries / Q000000981:diagnostic imaging* / Q000601:surgery; D019091:Critical Pathways; D006465:Hemoperitoneum / Q000000981:diagnostic imaging* / Q000601:surgery; D006801:Humans; D008297:Male; D010490:Pericardial Effusion / Q000000981:diagnostic imaging* / Q000601:surgery; D011237:Predictive Value of Tests; D016032:Randomized Controlled Trials as Topic; D013898:Thoracic Injuries / Q000000981:diagnostic imaging* / Q000601:surgery; D014057:Tomography, X-Ray Computed / Q000379:methods; D014463:Ultrasonography; D014950:Wounds, Penetrating / Q000000981:diagnostic imaging* / Q000601:surgery; D055815:Young Adult