Focused assessment with sonography for trauma in the prehospital setting

Introduction

Previous studies have focused on the accuracy of the focused assessment with sonography for trauma (FAST) examination performed in the emergency department (ED), but have not evaluated FAST performed in the field setting (field FAST). We aimed to evaluate the accuracy of field FAST by comparison with FAST performed in the ED.

Methods

A total of 1,380 trauma patients were admitted to our hospital by air ambulance between April 2005 and October 2009. We compared the sensitivity and specificity of field FAST with those of FAST in the hospital setting. The presence of pericardial and intraperitoneal fluid was confirmed by the medical records.

Results

Of these patients, 317 blunt trauma patients (mean age, 43.9 ± 23.8 (SD) years) were examined by field FAST and enrolled in the study; all participants were also examined by FAST in the ED. The mean Injury Severity Score was 16.1 ± 15.4 (SD). Forty-seven patients (14.8%) were ultimately diagnosed with pericardial and intraperitoneal fluid. Field FAST detected 12 of these cases. The sensitivity of field FAST was significantly lower than that of FAST in the ED (P < 0.01), whereas the specificities of FAST in the two settings were not significantly different. Emergency surgery was performed in nine of the 12 patients who were positive with field FAST.

Conclusions

Because the sensitivity of field FAST is low, repeated examination in ED is needed to improve diagnostic sensitivity. However, field FAST may be an effective tool for early detection of critical blunt trauma and as a rapid indicator for surgery.

Table 1 abstract P284