title: Chest Abdominal-Focused Assessment Sonography for Trauma during the primary survey in the Emergency Department: the CA-FAST protocol.
abstract: OBJECTIVE
  To evaluate the feasibility of a new protocol, Chest Abdominal-Focused Assessment Sonography for Trauma (CA-FAST), during the primary survey and to estimate its diagnostic accuracy when compared with thoracoabdominal computed tomography (CT) scan.
  
  
  METHODS
  A prospective accuracy study was performed from November 2012 to November 2013 at the Emergency Department. Only adult trauma patients who underwent a CA-FAST examination prior to a thoracoabdominal CT scan were enrolled. In addition to standard patterns detected by Extended-FAST (E-FAST) such as pneumothorax (PTX), hemothorax (HTX), pericardial and intraabdominal effusion, CA-FAST protocol also included the research of lung contusions (LCs).
  
  
  RESULTS
  Six hundred and one patients were enrolled. The mean time for protocol execution was 7 ± 3 min. Chest ultrasonography showed the following results (all p < 0.001): LCs sensitivity 59 %, specificity 98 %, positive predictive value (PPV) 92 %, negative predictive value (NPV) 86 %, accuracy 87 %; PTX sensitivity 84 %, specificity 98 %, PPV 93 %, NPV 95 %, accuracy 95 %; HTX sensitivity 82 %, specificity 97 %, PPV 87 %, NPV 95 %, accuracy 94 %. The standard 4-views FAST examination showed a diagnostic accuracy of 91 % with a sensitivity of 75 %, specificity of 96 %, PPV of 81 % and NPV of 94 %.
  
  
  CONCLUSIONS
  According to our results CA-FAST protocol proved to be a rapid bedside method, with good accuracy and high NPV in detection of ultrasonographic patterns suggestive of serious injury in trauma patients; moreover, the additional research of LCs did not cause a delay in the diagnosis. Ultrasonography should be used as initial investigation during the primary survey, sending to further diagnostic studies (CT scan) only those patients not clearly classified.
authors.affiliation: Emergency Department, Careggi University Hospital, Largo Brambilla, 3, 50134, Florence, Italy. zanomau@libero.it.
authors.forename: M
authors.initials: M
authors.lastname: Zanobetti
authors.affiliation: Emergency Department, Careggi University Hospital, Largo Brambilla, 3, 50134, Florence, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Coppa
authors.affiliation: Emergency Department, Careggi University Hospital, Largo Brambilla, 3, 50134, Florence, Italy.
authors.forename: P
authors.initials: P
authors.lastname: Nazerian
authors.affiliation: Emergency Department, Careggi University Hospital, Largo Brambilla, 3, 50134, Florence, Italy.
authors.forename: S
authors.initials: S
authors.lastname: Grifoni
authors.affiliation: Emergency Department, Careggi University Hospital, Largo Brambilla, 3, 50134, Florence, Italy.
authors.forename: M
authors.initials: M
authors.lastname: Scorpiniti
authors.affiliation: Emergency Department, Careggi University Hospital, Largo Brambilla, 3, 50134, Florence, Italy.
authors.forename: F
authors.initials: F
authors.lastname: Innocenti
authors.affiliation: Emergency Department, Careggi University Hospital, Largo Brambilla, 3, 50134, Florence, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Conti
authors.affiliation: Emergency Department, Careggi University Hospital, Largo Brambilla, 3, 50134, Florence, Italy.
authors.forename: S
authors.initials: S
authors.lastname: Bigiarini
authors.affiliation: Emergency Department, Careggi University Hospital, Largo Brambilla, 3, 50134, Florence, Italy.
authors.forename: S
authors.initials: S
authors.lastname: Gualtieri
authors.affiliation: Emergency Department, Careggi University Hospital, Largo Brambilla, 3, 50134, Florence, Italy.
authors.forename: C
authors.initials: C
authors.lastname: Casula
authors.affiliation: Emergency Department, Careggi University Hospital, Largo Brambilla, 3, 50134, Florence, Italy.
authors.forename: P F
authors.initials: PF
authors.lastname: Ticali
authors.affiliation: Emergency Department, Careggi University Hospital, Largo Brambilla, 3, 50134, Florence, Italy.
authors.forename: R
authors.initials: R
authors.lastname: Pini
mesh_terms: D000007:Abdominal Injuries / Q000000981:diagnostic imaging*; D002985:Clinical Protocols; D004636:Emergency Service, Hospital; D005260:Female; D000077564:Focused Assessment with Sonography for Trauma; D006801:Humans; D007558:Italy; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D013898:Thoracic Injuries / Q000000981:diagnostic imaging*; D014057:Tomography, X-Ray Computed; D014949:Wounds, Nonpenetrating / Q000000981:diagnostic imaging*
keywords: Diagnosis; Emergency medicine; Emergency ultrasonography; Trauma