The application of focused assessment with sonography for trauma in resource-limited settings: a scoping review

Trauma represents a leading cause of mortality and disability in resource-limited settings. However, access to advanced imaging modalities is severely constrained, limiting timely and accurate diagnosis as well as clinical decision-making. Focused assessment with sonography for trauma (FAST) offers a portable, non-ionizing, and cost-effective bedside imaging solution with significant potential for clinical application. It enables rapid identification of life-threatening hemoperitoneum or hemothorax, thereby guiding immediate surgical intervention or preventing unnecessary patient transfers. As such, FAST contributes to improved triage, reduced decision-making time, and enhanced efficiency in trauma care delivery within these contexts. Nevertheless, there remains a lack of comprehensive synthesis regarding its implementation models, effectiveness, and associated challenges in low-resource environments.

Adhering to the PRISMA 2020 guidelines, a systematic literature search was conducted across six databases-PubMed, Embase, Cochrane Library, Scopus, Web of Science, and SinoMed-up to October 11, 2025. Study screening, quality assessment, and data extraction were performed independently, resulting in the inclusion of 29 eligible studies.

The synthesis of 29 included studies demonstrates that FAST is a highly effective tool in resource-limited settings. It exhibits high specificity (94%-100%) in detecting free intraperitoneal fluid, supporting reliable clinical decision-making. FAST has been successfully integrated into diverse healthcare contexts, including pre-hospital emergency response and primary care clinics. A critical enabler of its implementation is task-shifting, with nurses, general practitioners, and other non-specialist healthcare providers serving as primary operators. Nonetheless, persistent challenges include limited equipment availability and difficulties in maintaining operator competency, underscoring the need for innovative solutions such as remote tele-guidance, cascade training programs, and the development of local training capacity.

As a rapid, portable, and cost-efficient diagnostic modality, FAST plays a vital role in strengthening trauma care systems in resource-limited settings. Despite existing limitations, its sustainable scale-up depends on the integration of technological access, robust training frameworks, and supportive health policies. Such a multifaceted approach is essential to improving survival rates and long-term outcomes for trauma patients in these regions and advancing global trauma care equity.

https://doi.org/10.17605/OSF.IO/2T7BK.