Surgeon-Performed Ultrasound for the Assessment of Truncal Injuries

TLDR

The study assessed the accuracy of FAST performed by trauma team members over three years and identified the clinical scenarios in which it is most reliable. FAST examinations were conducted on 1,540 trauma patients (1,227 blunt, 313 penetrating), with positive findings prompting immediate surgery for hemopericardium or CT/urgent celiotomy for hemoperitoneum depending on hemodynamic stability. FAST demonstrated an overall sensitivity of 83.3% and specificity of 99.7%, achieving 100% sensitivity and 99.3–100% specificity for precordial/transthoracic wounds and hypotensive blunt torso trauma, supporting its use as the first diagnostic tool and justifying immediate surgery when positive.

Abstract

To determine the accuracy of the Focused Assessment for the Sonographic examination of the Trauma patient (FAST) when performed by trauma team members during a 3-year period, and to determine the clinical conditions in which the FAST is most accurate in the assessment of injured patients.The FAST is a rapid test that sequentially surveys the pericardial region for hemopericardium and then the right and left upper quadrants and pelvis for hemoperitoneum in patients with potential truncal injuries. The clinical conditions in which the FAST is most accurate in the assessment of injured patients have yet to be determined.FAST examinations were performed on patients with precordial or transthoracic wounds or blunt abdominal trauma. Patients with a positive ultrasound (US) examination for hemopericardium underwent immediate surgery, whereas those with a positive US for hemoperitoneum underwent a computed tomography scan (if they were hemodynamically stable) or immediate celiotomy (if they were hemodynamically unstable- blood pressure < or = 90 mmHg).FAST examinations were performed in 1540 patients (1227 with blunt injuries, 313 with penetrating injuries). There were 1440 true-negative results, 80 true-positive results, 16 false-negative results, and 4 false-positive results; the sensitivity was 83.3%, the specificity 99.7%. US was most sensitive and specific for the evaluation of patients with precordial or transthoracic wounds (sensitivity 100%, specificity 99.3%) and hypotensive patients with blunt abdominal trauma (sensitivity 100%, specificity 100%).US should be the initial diagnostic modality for the evaluation of patients with precordial wounds and blunt truncal injuries because it is rapid and accurate. Because of the high sensitivity and specificity of US in the evaluation of patients with precordial wounds and hypotensive patients with blunt torso trauma, immediate surgical intervention is justified when those patients have a positive US examination.