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Not so FAST.

M Todd Miller1, Michael D Pasquale, William J Bromberg

  • 1Division of Trauma/Surgical Critical Care, Lehigh Valley Hospital, Cedar Crest & I-78, P.O. Box 689, Allentown, PA 18105-1556, USA.

The Journal of Trauma
|January 25, 2003
PubMed
Summary
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Focused assessment with sonography for trauma (FAST) underdiagnoses blunt abdominal injuries in stable patients. Routine computed tomographic (CT) scanning is recommended for accurate diagnosis and improved patient outcomes.

Area of Science:

  • Emergency Medicine
  • Radiology
  • Trauma Surgery

Background:

  • The Focused Assessment with Sonography for Trauma (FAST) is a screening tool for blunt abdominal trauma.
  • Underdiagnosis of abdominal injuries can impact treatment and outcomes in trauma patients.

Purpose of the Study:

  • To evaluate the effectiveness of FAST as a screening tool for blunt abdominal injury (BAI) in hemodynamically stable trauma patients.
  • To compare FAST examination results with computed tomographic (CT) scanning findings.

Main Methods:

  • A protocol was implemented using FAST as a screening tool for BAI in hemodynamically stable trauma patients.
  • Patients underwent a four-view FAST examination followed by abdominal/pelvic CT scan within 1 hour.
  • FAST examination was considered positive for free intra-abdominal fluid; results were compared with CT findings.

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Main Results:

  • FAST examination demonstrated a sensitivity of 42% and a specificity of 98% for hemoperitoneum when compared to CT scanning.
  • Significant discordance was observed between FAST and CT scan findings (p < 0.001).
  • Six patients with false-negative FAST examinations required laparotomy; 19 true-negative FAST patients had intra-abdominal injuries without hemoperitoneum.

Conclusions:

  • The FAST examination results in underdiagnosis of intra-abdominal injury in hemodynamically stable trauma patients.
  • This underdiagnosis may negatively impact patient treatment and outcomes.
  • Hemodynamically stable patients with suspected BAI should undergo routine CT scanning for accurate diagnosis.