Is the FAST Exam Actually Fast? Utilizing Trauma Video Review to Assess FAST User Performance

While the Focused Assessment with Sonography for Trauma (FAST) is lauded for its speed and efficacy, its proficiency among surgical trainees remains underexplored. We aim to assess the performance of surgical trainees in conducting FAST exams in real-world settings using trauma video review (TVR).

This cross-sectional study included blunt trauma activations between July-December 2023 that were recorded using TVR and had a FAST performed. Total and net FAST times (with and without interruptions) were collected. Two radiologists independently scored the diagnostic quality and technical imaging technique of saved clips using a Task Specific Checklist (TSC). FAST findings were compared with confirmatory tests (CT-scan and surgical findings) to assess diagnostic accuracy.

Ninety-three FAST exams were analyzed (median total time = 2.9 minutes [2.28-4.40], and net time = 2.33 minutes [1.87-3.08]). Around 80% of cases (41/51 cases for which clips were saved) exhibited at least one nondiagnostic quality anatomic window, with average modified-TSC scores ranging from 3/5 to 3.65/5, suggesting that moderate to mild improvements in quality are needed. Only 20% of cases (10/51) were found to have clips of diagnostic quality on all four anatomic windows, with trainees averaging a total-TSC score of 17.9/24, indicating proficiency in task completion. Intraperitoneal free blood was found in 6/11 positive FASTs, with a sensitivity and specificity among our trainees of 54% and 92%, respectively.

While trainees can complete the FAST within a short time frame, the quality and diagnostic accuracy require significant improvement. These results highlight the need for enhanced training programs to ensure both quality and accuracy are optimized.