FAST enough? A validation study for focused assessment with sonography for trauma ultrasounds in a Level II trauma center

Abstract

The Focused Assessment with Sonography for Trauma (FAST) is widely used as the initial screening tool for abdominal trauma. Several recent studies have questioned its use. Using the Trauma Registry, 1 year of data at a Level II trauma center were reviewed. All trauma patients with dictated FAST examinations were identified. Disconcordant findings were reviewed. Predictive values for determining intraperitoneal injuries were calculated. Nine hundred seventy-four designated trauma patients were entered into the Trauma Registry. Of these, 633 had dictated FAST examinations. There were 533 true-negatives, 11 true-positives, 77 false-negatives, and six false-positives. Of the 77 false-negatives, 33 had retroperitoneal injuries and 25 had intraperitoneal injuries. No adverse outcomes were identified from diagnostic delay. For predicting intraperitoneal injury, FAST had a negative predictive value of 96 per cent, positive predictive value of 63 per cent, sensitivity of 29 per cent, specificity of 99 per cent, and accuracy of 95 per cent. Our data demonstrate that FAST was useful for the initial assessment of intraperitoneal injuries. FAST was 95 per cent accurate and allowed for rapid triage to operative management when indicated. The data also confirm that a negative FAST does not exclude abdominal injury.