The Benefits of FAST Examination in Trauma Assessment

FAST (Focused Assessment with Sonography for Trauma) ultrasound is a point of care ultrasound technique used for rapid assessment of patients with suspected internal bleeding due to trauma.

The primary goal of the examination in a trauma patient is to identify intraperitoneal free fluid  providing an opportunity for immediate transfer to CT, higher levels of care, etc.

Many articles have been published describing the advantages and disadvantages of this examination (1,2). Rapid examination has been reported with a sensitivity of ~90% (range 75-100%) and a specificity of ~95% (range 88-100%) for detecting intraperitoneal free fluid (3). The sensitivity for detecting organ injuries is much lower.

Most studies in emergency medical literature suggest that intraperitoneal free fluid will not be identified by ultrasound until more than 500 ml is present. Therefore, a negative examination will not exclude bleeding that will eventually become significant (4).

Some studies have not shown a significant difference in diagnostic accuracy between radiologists and non-radiologists (5). The FAST examination emerges as a valuable asset in trauma assessments, providing clinicians with rapid, reliable insights crucial for effective decision-making in emergency situations.

References

1. Dolich MO, McKenney MG, Varela JE et-al. 2,576 ultrasounds for blunt abdominal trauma. J Trauma. 2001;50 (1): 108-12. 
2. Natarajan B, Gupta PK, Cemaj S et-al. FAST scan: is it worth doing in hemodynamically stable blunt trauma patients?. Surgery. 2010;148 (4): 695-700. 
3. Brenchley J, Walker A, Sloan JP et-al. Evaluation of focussed assessment with sonography in trauma (FAST) by UK emergency physicians. Emerg Med J. 2006;23 (6): 446-8. 
4. Emergency ultrasound guidelines. (2009) Annals of emergency medicine. 53 (4): 550-70.
5. Bhoi S, Sinha TP, Ramchandani R et-al. To determine the accuracy of focused assessment with sonography for trauma done by nonradiologists and its comparative analysis with radiologists in emergency department of a level 1 trauma center of India. J Emerg Trauma Shock. 2013;6 (1): 42-6.