Objective: To evaluate the accuracy of the focused assessment with sonography for trauma (FAST) exam performed with a digital handheld ultrasound machine in the emergency evaluation and resuscitation of trauma victims.Introduction: The FAST exam is a valuable screening tool in the evaluation of abdominal trauma. New digital ultrasound units have recently become available which can be hand-carried by clinicians responding to the earliest phases of trauma care. Materials and Methods: Forty-seven victims of blunt trauma and 3 victims of penetrating trauma underwent FAST examinations performed by an attending trauma surgeon. Scans were performed with a SonositeTM 180, 2.4-kg machine utilising a 5-2 MHz curved array transducer. The results of the hand-held FAST were compared with formal sonographic examinations performed by radiology department personnel, computed tomographic (CT) studies, operative findings and ultimate hospital course. Results: In victims of blunt trauma, 7 of 8 true fluid collections were detected, and 38 out of 39 cases without the presence of fluid were correctly excluded. There was 1 false positive and 1 false negative determination, resulting in a sensitivity of 86%, specificity of 97%, positive predictive value of 88%, and a negative predictive value of 97%. The overall accuracy was 96% for victims of blunt trauma. The technique expediently detected intra-peritoneal bleeding in 2 victims of lateral penetrating abdominal trauma. Utilised as the initial component of a diagnostic protocol, no inappropriate management strategies were suggested. Conclusions: Digital hand-held sonography by clinicians can accurately allow the early performance of FAST exams. This exam may accurately and safely extend the physical senses of the examining physician.
On a global basis, the use of ultrasonography to assist clinicians in obtaining timely diagnoses in abdominal trauma is not particularly new. The first reported case of sonography to evaluate patients with splenic haematomas was in 1971, and by 1976, series of up to 70 victims of blunt trauma were available.
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