FAST Scan: Is it Worth Doing in Hemodynamically Stable Blunt Trauma Patients?

Abstract

This retrospective chart review of 2105 trauma patients presenting to a level I trauma center sought to evaluate the role of focused assessment with sonography for trauma (FAST) in the diagnostic evaluation of hemodynamically stable blunt trauma patients. FAST was performed on all trauma patients by surgery residents as part of the secondary survey. Patients with positive FAST results underwent confirmatory testing, including computed tomography (CT), diagnostic peritoneal lavage, and exploratory laparotomy. Negative FAST results were either observed (for an unspecified time period) or underwent confirmatory testing. Of the 2105 patients, 93 had a positive FAST (88 confirmed true positive, 5 false positive). The remaining 2012 had a negative FAST (1896 confirmed true negative, 118 false negative). Of note, 16/88 true positive and 22/118 false negative patients were reported as penetrating injuries. Missed injuries found on CT scans were reported in 99/118 patients, including injuries to: spleen, liver, pelvis, bowel, urinary system, retroperitoneal hematoma, diaphragm, adrenal, and vessels. The authors calculated the overall sensitivity of FAST in this study to be 43%, specificity of 99%, and positive and negative predictive value (PPV, NPV) of 95% and 94%, respectively. When narrowing to hemodynamically stable blunt trauma patients, they reported a sensitivity of 41%, specificity of 99%, PPV of 94%, and NPV of 95%. The authors concluded that FAST in hemodynamically stable blunt trauma patients is not worthwhile and should be reserved for hemodynamically unstable patients.