Focused assessment with sonography in trauma as a triage tool

Abstract

We congratulate Xiang et al [1] for their study describing triage strategies adopted during the postearthquake period with numerous pediatric casualties. We want to highlight the role of the focused assessment with sonography in trauma (FAST). It offers a reliable tool not only for trauma treatment but also during triage that can be used successfully as a screening tool specifically in children. Focused assessment with sonography in trauma has now become an extension of the physical examination and helps detect lifethreatening injuries within the “golden hour” and allows appropriate triage of the patients [2,3]. Many surgeons now consider it as a standard part of the pediatric trauma evaluation during disaster. In 1997, an international consensus conference committee defined the acronym FAST to describe the application of ultrasound in the initial evaluation of trauma patients [3]. The development of handheld ultrasound devices facilitated the introduction of FAST into prehospital trauma management and caused significant changes in the triage of multiple injured patients. The use of ultrasound has focused on the FAST examination as a major adjunct to triage and management of illness as well as patient assessment. There are several factors that should be considered when using FAST. It should be used as an initial screening method to identify patients at risk. It does not provide a definitive diagnosis. Time should not be wasted in trying to identify organ lesions. Adequate training and experience are crucial for accurate ultrasound examination, as the quality of the evaluation is highly user dependent and must not delay patient management. Emergency bedside sonography for victims of blunt abdominal trauma was one of the first applications for ultrasound. In assessing the need for laparotomy in children, FAST scan alone has a sensitivity of 70% and specificity of 100%; but when combined with physical examination, the sensitivity rose to 100% [4]. Ultrasound examination has been useful in the diagnosis of shock for assessing cardiac function, for detecting increased intracranial pressure by measuring the optic nerve sheath diameter, for identifying abscess (or foreign body), and for safe incision and drainage. The predominance of orthopedic trauma is described in the postearthquake period. Hubner et al [5] reported a sensitivity of 91% in the diagnosis of skeletal fractures with ultrasound. Based on their exceptional experience, we would like to know the authors' thoughts concerning the role of FAST in triage strategies.