Abstract
IntroductionThe focused assessment with sonography in trauma (FAST) exam is a critical diagnostic test for intraperitoneal free fluid (FF). Current teaching is that fluid accumulates first in Morison’s pouch. The goal of this study was to evaluate the “sub-quadrants” of traditional FAST views to determine the most sensitive areas for FF accumulation.MethodsWe analyzed a retrospective cohort of all adult trauma patients who had a recorded FAST exam by emergency physicians at a Level I trauma center from January 2012 – June 2013. Ultrasound fellowship-trained faculty with three emergency medicine residents reviewed all FAST exams. We excluded studies if they were incomplete, of poor image quality, or with incorrect medical record information. Positive studies were assessed for FF localization, comparing the traditional abdominal views and on a sub-quadrant basis: right upper quadrant (RUQ)1 - hepato-diaphragmatic; RUQ2 - Morison’s pouch; RUQ3 - caudal liver edge and superior paracolic gutter; left upper quadrant (LUQ)1 - splenic-diaphragmatic; LUQ2 - spleno-renal; LUQ3 – around inferior pole of kidney; suprapubic area (SP)1 - bilateral to bladder; SP2 - posterior to bladder; SP3 – posterior to uterus (females). FAST results were confirmed by chart review of computed tomography results or operative findings.ResultsOf the included 1,008 scans, 48 (4.8%) were positive. The RUQ was the most positive view with 32/48 (66.7%) positive. In the RUQ sub-quadrant analysis, the most positive view was the RUQ3 with 30/32 (93.8%) positive.ConclusionThe RUQ is most sensitive for FF assessment, with the superior paracolic gutter area around the caudal liver edge (RUQ3) being the most positive sub-quadrant within the RUQ.
Highlights
The focused assessment with sonography in trauma (FAST) exam is a critical diagnostic test for intraperitoneal free fluid (FF)
The right upper quadrant (RUQ) is most sensitive for FF assessment, with the superior paracolic gutter area around the caudal liver edge (RUQ3) being the most positive sub-quadrant within the RUQ. [West J Emerg Med. 2017;18(2)270-280.]
We analyzed a retrospective cohort of all adult trauma patients with recorded FAST exams by emergency medicine (EM) resident physicians of all levels of training at a Level 1 trauma center from January 2012 – June 2013
Summary
The focused assessment with sonography in trauma (FAST) exam is a critical diagnostic test for intraperitoneal free fluid (FF). The focused assessment with sonography in trauma (FAST) exam is a critical screening tool for intraperitoneal free fluid (FF) assessment from traumatic injury by evaluating the subxiphoid, right upper quadrant (RUQ), left upper quadrant (LUQ), and suprapubic (SP) areas.[1,2,3] It is commonly taught that FF will first accumulate in the most dependent parts of the abdomen and pelvis in a supine trauma patient, the RUQ and pelvis.[1,4] The hepato-renal space (Morison’s pouch) has been concluded to be the primary area where FF is initially seen.[4] much of the current emphasis on the performance of the FAST exam has been placed on the RUQ Morison’s pouch view.[1,5]. Several radiology studies using computed tomography (CT) and US scans have illustrated that FF layers to the most dependent areas in a supine patient (Figure 1), and best seen in the RUQ. 7,8
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