Advanced ultrasonic diagnosis of extremity trauma: the FASTER examination

Ultrasound is of proven accuracy in abdominal and thoracic trauma and may be useful for diagnosing extremity injury in situations where radiography is not available such as military and space applications. We prospectively evaluated the utility of extremity ultrasound performed by trained, nonphysician personnel in patients with extremity trauma to simulate remote aerospace or military applications.

Patients with extremity trauma were identified by history, physical examination, and radiographic studies. Ultrasound examination was performed bilaterally by nonphysician personnel, blinded to radiographic results, with a portable ultrasound device using a 10- to 5-MHz linear probe. Images were videorecorded for later analysis against radiography by Fisher's exact test.

There were 158 examinations performed in 95 patients. The average time of examination was 4 minutes. Ultrasound accurately diagnosed extremity injury in 94% of patients with no false-positive examinations; accuracy was greater in midshaft locations and least in the metacarpal/metatarsals. Soft tissue/tendon injury was readily visualized.

Extremity ultrasound can be performed quickly and accurately by nonphysician personnel with excellent accuracy. Pulmonary ultrasound appears promising; blinded verification of the utility of ultrasound in patients with extremity injury should be performed to determine whether extremity and respiratory evaluation should be added to the FAST examination (the FASTER examination) and to verify the technique in remote locations such as military and aerospace applications.