Focused Assessment With Sonography For Trauma Scans Research Articles

Role of FAST in blunt trauma abdomen: A promising diagnostic tool to evaluate management in patients and comparison of its accuracy with CT and laparotomy

Background: Focused assessment with sonography for trauma (FAST) is a limited ultrasound examination directed solely at identifying the presence of free intraperitoneal or pericardial fluid. In the context of traumatic injury, free fluid is usually due to hemorrhage and contributes to the assessment of the circulation. Performed in the trauma room by properly trained and credentialed staff, it allows the timely diagnosis of potentially life-threatening hemorrhage and is a decision-making tool to help determine the need for transfer to the operating room, computed tomography (CT) scanner, or angiography suite. The FAST scan is a 4 view scan reliant on detecting the presence of fluid within the pericardium and most dependent zones of the peritoneum in the horizontal patient. It is capable of detecting more than 100–250 mL of free fluid. CT scanning, in comparison, is capable of detecting more than approximately 100 mL of free fluid in the abdominal cavity. As a “rule of thumb,” a rim of 0.5 cm of fluid in Morison’s pouch represents approximately 500 mL of free fluid, and a 1 cm rim represents approximately 1000 mL. Aims and Objectives: The aims of this study were as follows: Role of FAST in blunt trauma abdomen: A promising diagnostic tool to evaluate management in patients and comparison of its accuracy with CT and laparotomy. Materials and Methods: The FAST scan was performed by Color Doppler Siemens Sonoline G-50 machine using either 2–5 MHz convex transducers or 5–10 MHz linear transducer department of Radiology L.L.R. Hospital, Kanpur. At FAST examines four areas for free fluid, perihepatic and hepatorenal space, perisplenic, and pelvis pericardium. Results: Sensitivity of FAST: 87.5%, specificity of FAST: 75%, and negative predictive value (NPV) of FAST are 80%. CT scan had sensitivity of: 97%, specificity of: 95%, and positive predictive value of CT scan: 92% NPV of: 100%. Laparotomy was GOLD standard with specificity of 100%. Conclusion: FAST was positive in 62.5% cases of blunt trauma abdomen. Sensitivity of FAST: 87.5%, specificity of FAST: 75%, and NPV of FAST are 80%. CT scan had sensitivity of: 97%, specificity of: 95%, positive predictive value of CT scan: 92%, and NPV of: 100%. Laparotomy was GOLD standard with specificity of 100%.

Utility of Fast Scan in Blunt Abdominopelvic Trauma Patients in Lahore District

Background: To evaluate the utility of fast scan in blunt abdominopelvic trauma patients in the emergency department of tertiary care hospitals in Lahore district. Focused assessment with sonography for trauma (FAST) has been used as the first assessment in diagnosing patients with trauma in the last decade, and we have heard people questioning its authenticity and reliability, and many other things. Methodology: The study design was cross-sectional .This study was conducted at various tertiary care hospitals of Lahore, in the time duration of 3 months from January 2022 to March 2022. One hundred and six (106) patients with blunt abdominopelvic trauma were assessed by Fast scan using 2-5MHz transducer. Results: Out of 106 patients 59(55.7%) were males and 47(44.3%) were females with ages ranged between 2 to 72 years. Road traffic accidents accounted for 50% cases, 17% were due to fight while 23.6% were due to fall and 9.4% were due to assault. Of the total patients, 69.8% had negative scan while 30.2% had positive scan. Majority (6.6%) of positive scans were of splenic injury. Of all the positive scans 17% of the cases had abdominal pattern of injury while pelvic and abdominopelvic cases were 9.4% and 2.8% respectively. Practical implication: Our aim of doing this research study was to learn the benefits of performing Fast scan in BAT patients. We were able to look through possible aspects of pathology of abdomen and pelvic of traumatic patients arriving.FAST Scan is the single most valuable imaging modality in the early assessment and diagnosis of blunt abdominopelvic traumas with an aspect of safety &cost-effectiveness. Conclusion: Fast scan can be used in the initial assessment of blunt abdominopelvic trauma patients and it is verily preferred in hemodynamically stable patients. Keywords: FAST Scan, Blunt traumatic patients, Emergency department, Hemodynamic stability.

Accuracy of Focused Assessment with Sonography for Trauma Performed by Emergency Medicine Residents

Aim: To evaluate the accuracy of focused assessment with sonography for trauma (FAST) performed by emergency medicine residents to detect intra-peritoneal free fluid in blunt trauma patients. Design: Randomized control trial. Place and duration of study: Accident & Emergency Department, Mayo Hospital Lahore from 6th April 2022 to 5th November 2022. Methodology: One hundred and twenty one patients were included. FAST scan was performed in each patient by emergency resident as well as radiology resident. FAST was performed under direct supervision of radiology consultant. Furthermore, FAST reports were confirmed by patient follow up in first 24 hours by checking final outcome of patient based on results of abdominal computed tomography (CT), exploratory laparotomy or conservative management by admitting in surgical ward for observation and hemodynamic status change. Results: Focused assessment with sonography for trauma scan done by emergency residents showed free fluid in 20 patients (16.5%) while FAST done by radiology residents was positive in 21 (17.4%). Sensitivity of FAST performed by EM residents was 85.7% and specificity was 98%, while FAST done by radiology residents had sensitivity of 95.25 and specificity of 99%. Accuracy of FAST done by EM residents was 95.8% as final outcome. Conclusion: After training, emergency residents can perform FAST with high accuracy, similar to radiology residents in blunt abdominal trauma patients. Keywords: Focused assessment with sonography for trauma (FAST), Trauma, Blunt abdominal trauma

Clinical utility of performing FAST scan in hemodynamically stable patients presenting with blunt abdominal trauma in level one trauma center

Background: Focused assessment with sonography for trauma (FAST) has a role in the rapid screening of hemodynamically unstable patients to decide on management, however, its role in hemodynamically stable patients remains equivocal. Objectives: This study aimed to determine the sensitivity and specificity rate of FAST for intra-abdominal injury (IAI) in hemodynamically stable blunt abdominal trauma patients. Secondary outcomes like Glasgow coma score, length of hospital stays (LOS), head injury, and mortality were also examined for their association with FAST scan results. Settings and Design: A retrospective cross-sectional study was conducted in level-one trauma center in Bahrain. Methods: This study was conducted from January 2019 to October 2020. A total of 191 trauma codes were activated during this period, however, only 112 patients were included based on the inclusion criteria. Results: FAST scan in hemodynamically stable patients was found to have a higher specificity (96.7%) than sensitivity (30%) in this study. A higher negative predictive value (NPV) (86.4%) compared to a positive predictive value (66.6%) and a high accuracy rate (84.8%) was observed. LOS showed significant association only with FAST diagnostic accuracy. Conclusion: In hemodynamically stable patients; FAST is better at ruling in intra IAI when compared to ruling out and its high NPV supports it being a good screening tool. The results do not support the use of FAST as the sole diagnostic tool without performing computed tomography scan.

“Hiding beaver tail liver”: a rare case report of a beaver tail liver lookalike variant located medially to the spleen, mimicking a perisplenic hematoma

BackgroundLiver lobe anatomic variations are uncommon and may often cause clinical difficulties. We present a trauma patient with a previously unreported (to our knowledge) hepatic morphology, which was initially misdiagnosed as a possible perisplenic hematoma, leading to unnecessary further investigations.Case presentationA 32-year-old male patient was brought to our hospital’s emergency department following a low-energy motor vehicle accident. The patient was ambulatory, had a GCS of 15/15, and appeared hemodynamically stable with normal hematocrit (Hct)/hemoglobin (Hb) blood counts. No clinical signs/symptoms of bleeding were noted, and no significant complaints were documented, besides minor left flank tenderness with overlying abrasions. The patient's past medical history was insignificant. FAST (Focused Assessment with Sonography for Trauma) scan performed gave the impression of a crescent-shaped hypoechoic lesion/collection medially to the spleen, raising suspicion of a perisplenic hematoma. Subsequent computed tomography (CT) scan displayed no trauma-related findings, while the suspected hematoma was seen to correspond to variant left hepatic lobe morphology.ConclusionThe “hiding beaver tail liver” (HBTL) is a hepatic morphology variant encountered when the lateral part of the left liver lobe (beaver’s tail) extends across the midline and lies medially to the visceral surface of the spleen, following an acute angulation (in hiding). As it can mimic true pathology, familiarity with this morphology is crucial to avoid false diagnosis and unnecessary investigations.

Focused Assessment with Sonography for Trauma (FAST) Scan Versus Exploratory Laparotomy in Patients with Blunt Abdominal Trauma

Objective: To determine the diagnostic accuracy of FAST scans in patients with blunt abdominal trauma keeping exploratory laparotomy as a gold standard.
 Study Design: Cross-sectional validation study.
 Place and Duration of Study: Surgical Unit of Combined Military Hospital Kohat from Jan 2019 to June 2019.
 Methodology: Trauma patients reporting to the emergency department had a FAST scan using a portable ultrasound machine. The radiologist performed and interpreted the scans within one hour of the patient's arrival. The four standard views were obtained. Those who had positive FAST scans underwent a laparotomy without further evaluation. Patients with negative FAST scans did not have laparotomy unless unstable. Only those patients who underwent laparotomy were included in our study.
 Results: Out of 70 cases, comparison of the FAST scans in patients with blunt abdominal trauma keeping exploratory laparotomy as the gold standard to diagnose intra-abdominal injury was recorded as 88.88%, 82.35%, 94.00%, 70.00% and 87.14% for sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy respectively.
 Conclusion: Diagnostic accuracy of FAST scan in diagnosing intra-abdominal injury is higher, so it can be used routinely to diagnose intra-abdominal injury as a result of blunt abdominal trauma

Simulation-based clinical learning for final year medical students about Focused Assessment Sonography for Trauma

Background/Aim: Point-of-care ultrasound is a focused exam. It is a method that can be easily repeated by clinicians, especially as it aims for answering specific questions. The current study aimed to evaluate how successfully the students could learn Focused Assessment with Sonography for Trauma (FAST) and the permanence of the education after the simulation-based training. Methods: This study was conducted with final year medical students in Acibadem Mehmet Ali Aydinlar University Hospital Emergency Department and Acibadem University Center of Advanced Simulation and Education. The FAST course was taught by emergency physician specialists. After 2 h of theoretical training, a 3-h hands-on small group practical session was held face-to-face in which the students performed FAST scans with a CAE Vimedix high-fidelity simulator. After ultrasound training, the participants were separated into three groups of 20 each. One group was considered a control group in which they did not perform FAST on any real patient during the emergency medicine rotation (Group A). Group B performed FAST on 20 real patients, and Group C performed the technique on 40 real patients in the emergency department. A re-evaluation exam was done six months later. Results: This study included 60 participants. At the end of the first evaluation, the mean scores of Groups A (Control Group), B, and C were 6.05 (1.72), 6.05 (1.27), and 5.55 (13.2), respectively. The second evaluation results were 2.51 (0.51) with P < 0.001) and 8.84 (0.73) with a P < 0.001, and 9.71 (0.27) with P < 0.001, respectively. Conclusion: The long-term memory retention of the training presented in the simulation alone may be controversial. In our study, the take-home point is that for 2 h of theoretical lectures and 3 h of simulation training to be permanently retained, practicing the technique with at least 20 patients is needed.

The Role of Focused Assessment with Sonography for Trauma (FAST) in Children with Stable Hemodynamics after Blunt Abdominal Trauma:the Spleen and Hepatic Rupture Case Series

Introduction: The most prevalent type of abdominal trauma in children is blunt abdominal trauma (BAT). Traffic accidents and falls are the most prevalent causes of trauma. In this case, a CT scan is the gold standard for detecting BAT. However, there are several limits to this examination, particularly in terms of availability, cost, and radiation exposure. In BAT, FAST assists in the detection of intraabdominal free fluid. Case Description: Three pediatric patients with stable hemodynamics underwent BAT in this case series. All three patients were below 17 years old and had stomach discomfort due to a traffic accident. All three patients tested positive for FAST. Then, a contrast CT scan of the abdomen revealed a splenic rupture in the three patients and a splenic rupture and liver rupture in one of them. All the patients were hemodynamically stable before being treated with symptomatic medicines in a conservative (non-surgical) manner. All of the patients had satisfactory outcomes and could return home without undergoing surgery. Conclusion: Both FAST and CT scans do not affect therapeutic care, that were conservative management in these patients with stable hemodynamics. As a result, FAST may be a less expensive examination alternative, reducing radiation exposure and lowering the risk of cancer in children in the future.

Traumatic Small Bowel Injury: A Diagnosis Challenge

Traumatic small bowel injury is rare complication following a blunt abdominal trauma. We encountered a case of small bowel injury following a motor vehicle accident that was initially missed during the first presentation due to unremarkable findings in examination. Patient re-presented five days later with bowel ischaemia and was managed accordingly. It is a challenge in diagnosing the injury due to its vague presentation. The usage of Focused Assessment with Sonography for Trauma (FAST) scan as a screening tool in Emergency Department to pick up intra-abdominal injury do have limitations especially in diagnosing small bowel perforation post blunt abdominal trauma. The early phase of small bowel injury post blunt abdominal trauma rarely produces significant free fluid during the FAST scan. It is paramount for the emergency doctors to have a high level of suspicion in high risk cases to provide early supportive treatment and early referral to surgical team. If left undiagnosed bowel ischaemia may lead to catastrophic complication affecting the patient’s morbidity and mortality. In conclusion, each case should be managed and risk stratify individually. Computed tomography abdomen is found to be more superior in detecting bowel injuries, hence, and investigation of choice compared to bedside ultrasonograpy in cases with high level of suspicaion.

Assessment of blood consumption score for pediatrics predicts transfusion requirements for children with trauma.

Although transfusion is a primary life-saving technique, the assessment of transfusion requirements in children with trauma at an early stage is challenging. We aimed to develop a scoring system for predicting transfusion requirements in children with trauma.This was a case–control study that employed a nationwide registry of patients with trauma (Japan Trauma Data Bank) and included patients aged <16 years with blunt trauma between 2004 and 2015. An assessment of blood consumption score for pediatrics (ped-ABC score) was developed based on previous literatures and clinical relevance. One point was assigned for each of the following criteria: systolic blood pressure ≤90 mm Hg, heart rate ≥120/min, Glasgow coma scale (GCS) score <15, and positive focused assessment with sonography for trauma (FAST) scan. For sensitivity analysis, we assessed age-adjusted ped-ABC scores using cutoff points for different ages.Among 5943 pediatric patients with trauma, 540 patients had transfusion within 24 hours after trauma. The in-hospital mortality rate was 2.6% (145/5615). The transfusion rate increased from 7.6% (430/5631) to 35.3% (110/312) in patients with systolic blood pressure ≤90 mm Hg (1 point), from 6.1% (276/4504) to 18.3% (264/1439) in patients with heart rate ≥120/min (1 point), from 4.1% (130/3198) to 14.9% (410/2745) in patients with disturbance of consciousness with GCS score <15 (1 point), and from 7.4% (400/5380) to 24.9% (140/563) in patients with positive FAST scan (1 point). Ped-ABC scores of 0, 1, 2, 3, and 4 points were associated with transfusion rates of 2.2% (48/2210), 7.5% (198/2628), 19.8% (181/912), 53.3% (88/165), and 89.3% (25/28), respectively. After age adjustment, c-statistic was 0.76 (95% confidence interval, 0.74–0.78).The ped-ABC score using vital signs and FAST scan may be helpful in predicting the requirement for transfusion within 24 hours in children with trauma.

A 3-D-Printed Patient-Specific Ultrasound Phantom for FAST Scan

Ultrasound phantoms are commonly used to assess the performance of ultrasound systems and ensure their proper functionality, in addition to providing opportunities for medical training. However, Focused Assessment with Sonography for Trauma (FAST) phantoms, in particular, are prohibitively expensive and procedure specific. This work explores the use of additive manufacturing to fabricate a patient-specific, full-scale torso ultrasound phantom. Phantom geometry was derived from anonymized computed tomography scans and segments into discrete organs. The digital organs (torso, skeleton, liver, spleen) were 3-D printed and used as castable molds for producing their respective body features. These organs were integrated with artificial hemorrhages to produce a realistic training tool for FAST scans. The resulting phantom is low in cost, has a verified shelf-life of at least 1 y and was positively reviewed by a trauma and emergency radiologist for its ability to provide accurate geometric and ultrasound information.

Diagnostic accuracy of Focused Assessment with Sonography for Trauma for blunt abdominal trauma in the Eastern Region of Saudi Arabia.

Objectives:To determine the diagnostic accuracy of Focused Assessment with Sonography for Trauma (FAST) in blunt abdominal trauma caused by motor vehicle accidents at our Hospital in Dhahran city.Methods:This descriptive, observational study was conducted in the Radiology Department at King Fahad Military Medical Complex Dhahran, Saudi Arabia between September 2016 and September 2017. All adult patients (n=105) involved in motor vehicle accidents with blunt abdominal injury on presentation were retrospectively reviewed for FAST and CT scans for detection of free fluid. Focused assessment with sonography for trauma studies were conducted or supervised by senior registrar of general surgery (trauma team leader). Computed tomography findings were reviewed by 2 experienced radiologists. High and low-grade solid abdominal visceral (liver, spleen, kidney) injuries were identified on CT scans. Focused assessment with sonography for trauma and CT scan findings were identified as ‘positive’ and ‘negative’ for presence and absence of free fluid respectively. Outcomes of FAST were presented on a 2x2 contingency table.Results:Sensitivity of FAST in detecting intraperitoneal free fluid was calculated as 76.1% (95% confidence interval [CI], 64.14-85.69%), specificity 84.2% (95% CI, 68.75-93.98%) and accuracy 79% (95% CI, 70.01-86.38%). Focused assessment with sonography for trauma detected free fluid in most cases of high-grade solid visceral injuries. Nearly half of true-negative cases were having low grade visceral or other injuries.Conclusion:Focused assessment with sonography for trauma is an important tool in initial assessment of suspected blunt abdominal injury patients with high sensitivity and specificity. A negative FAST does not exclude low grade solid visceral or other injuries.

Diagnostic Accuracy of Focused Assessment with Sonography for Blunt Abdominal Trauma in Pediatric Patients Performed by Emergency Medicine Residents versus Radiology Residents.

Introduction:Focused assessment with sonography for trauma (FAST) has been shown to be useful to detect intraperitoneal free fluid in patients with blunt abdominal trauma (BAT). Objective:We compared the diagnostic accuracy of FAST performed by emergency medicine residents (EMRs) and radiology residents (RRs) in pediatric patients with BAT.Method:In this prospective study, pediatric patients with BAT and high energy trauma who were referred to the emergency department (ED) at Al-Zahra and Kashani hospitals in Isfahan, Iran, were evaluated using FAST, first by EMRs and subsequently by RRs. The reports provided by the two resident groups were compared with the final outcome based on the results of the abdominal computed tomography (CT), operative exploration, and clinical observation. Results:A total of 101 patients with a median age of 6.75 ± 3.2 years were enrolled in the study between January 2013 and May 2014. These patients were evaluated using FAST, first by EMRs and subsequently by RRs. A good diagnostic agreement was noted between the results of the FAST scans performed by EMRs and RRs (κ = 0.865, P < 0.001). The sensitivity, specificity, positive and negative predictive values, and accuracy in evaluating the intraperitoneal free fluid were 72.2%, 85.5%, 52%, 93.3%, and 83.2%, respectively, when FAST was performed by EMRs and 72.2%, 86.7%, 54.2%, 93.5%, and 84.2%, respectively, when FAST was performed by RRs. No significant differences were seen between the EMR- and RR-performed FAST. Conclusion:In this study, FAST performed by EMRs had acceptable diagnostic value, similar to that performed by RRs, in patients with BAT.

Factors affecting Objective Structured Clinical Examination scores of final year medical students in the evaluation of Focused Assessment with Sonography for Trauma

Background: Focused assessment with sonography for trauma (FAST) has become an initial evaluation in acute abdominal traumatic patients. Therefore, FAST skill is essential for the physician. Thus ultrasound (US) education is mandated. Nowadays there has been no standardized teaching and evaluation of FAST for undergraduate medical students. Objective: This study aimed to investigate the relationship between FAST scan experience during undergraduate training and the objective structured clinical examination (OSCE) score of the final year medical students that may help to design the methods in teaching FAST at the undergraduate level. Methods: This is a retrospective cohort study. Data including gender and grade point average (GPA) were collected. The FAST scan experience including the time of formal education on FAST scans, both didactic lecture and hands-on training, the number of FAST scans, the number of positive cases, and the level of confidence were surveyed by questionnaires. The students’ background characteristics were determined by the GPA. The students’ FAST skills were assessed by OSCE. These data were retrospectively collected and analyzed to establish their relationship with the OSCE score. Results: Forty-five final year medical students participated in this study. Overall, there was no significant relationship among prior FAST scan experience, students’ background characteristics, and the OSCE scores. There was a positive correlation for the time of lecture (R = 0.45, p = 0.002), the time of practical training (R = 0.47, p = 0.001), the number of FAST scans (R = 0.55, p < 0.001), and the level of confidence. Conclusions: FAST scan experience during an undergraduate training does not seem to affect the FAST examination performance. However, a formal US training and the number of FAST scans do effect on the level of students’ confidence. OSCE may not be the best tool to evaluate the FAST scan performance.

Predictive value of focused assessment with sonography for trauma (FAST) for laparotomy in unstable polytrauma Egyptians patients

PurposeThe emergency physicians face significant clinical uncertainty when multiple trauma patients arrive in the emergency department (ED). The priorities for assessment and treatment of polytrauma patients are established in the primary survey. Focused assessment with sonography for trauma (FAST) is very essential clinical skill during trauma resuscitation. Use of point of care ultrasound among the trauma team working in the primary survey in emergency care settings is lacking in Suez Canal University Hospitals even ultrasound machine not available in ED. This study aims to evaluate the accuracy of FAST in hemodynamically unstable polytraumatized patients and to determine its role as an indication of laparotomy. MethodsThis study is a cross-sectional study included 150 polytrauma patients with a blunt mechanism admitted in Suez Canal University Hospital. Firstly primary survey by airway check, cervical spine securing with neck collar, maintenance of breathing/circulation and management of life threading conditions if present were conducted accordingly to ATLS (advanced trauma life support) guidelines. The patients were assessed in the primary survey using the FAST as a tool to determine the presence of intra-abdominal collection. ResultsA total of 150 patients, and FAST scans were performed in all cases. The sensitivity and specificity were 92.6% and 100%, respectively. The negative predictive value was 92%, while the positive predictive value of FAST was 100%. The accuracy of FAST was 96%. ConclusionFAST is an important method to detect intra-abdominal fluid in the initial assessment in hemodynamically unstable polytrauma patients with high accuracy.

A closed loop audit on FAST scan documentation in the emergency department

Purpose: Focused assessment with sonography for trauma (FAST) scans are a useful bedside tool used in trauma to detect the presence of free fluid in the abdomen. This fast and effective skill enables quick decision-making for doctors with regarding to further imaging or moving straight to operations. However, documentation of these images is widely noted to be poor, especially when sonographers and radiologists require much more detailed and clear documentation.

Positive focused assessment sonography as an indication for laparotomy in hemodynamically unstable blunt traumatized patient

Objective The aim of this study was to evaluate the results of focused assessment with sonography for trauma (FAST) in hemodynamically unstable blunt traumatized patients and to determine its role in the diagnostic evaluation of these patients. Background The emergency physician faces significant clinical uncertainty when a multiple trauma patient arrives in the emergency department. Patients are assessed, and their treatment priorities are established in the primary survey. FAST is an important skill during trauma resuscitation. The use of point-of-care ultrasound among the trauma team working in the primary survey in emergency care settings is lacking in Menoufia university hospitals. Patients and methods This study was conducted on 50 patients with blunt abdominal trauma, either a localized trauma to the abdomen or a polytrauma with a blunt mechanism. The patients were assessed in the primary survey using the FAST as a tool to determine the presence of intra-abdominal collection. Results There were a total of 50 cases, and FAST scans were performed in all cases. The sensitivity and specificity were 92.6 and 100%, respectively. The negative predictive value was 92%, whereas the positive predictive value was 100%. The overall accuracy was 96%. Conclusion FAST with presence of free fluid intraperitoneal without reference to the amont is useful as the initial diagnostic tool for abdominal trauma to detect intra-abdominal fluid in hemodynamically unstable patients. FAST performed by clinicians detects intraperitoneal fluid with a high degree of accuracy. All FAST examinations are valuable tests when positive. However, ultrasound examination is operator dependent, and FAST scan has its own limitations. For negative FAST scan cases, we recommend a period of monitoring, serial FAST scans, or further investigations, such as computed tomography scan.

An Experiential Learning Model Facilitates Learning of Bedside Ultrasound by Preclinical Medical Students

To examine the effects of an experiential learning model of ultrasound training on preclinical medical students' knowledge and practice of Focused Assessment with Sonography for Trauma (FAST) examination. The study was conducted in 2 phases. In phase 1, first- and second-year medical students participated in a 45-minute didactic presentation and subsequent 1-hour hands-on practice followed by 3-5 precepted FAST examinations in the emergency department. A pretest or posttest design was used to examine the participants' knowledge interpreting ultrasound images of the FAST examination. In phase 2, students performed FAST scans on patients with abdominal complaints under the supervision of emergency ultrasound faculty over a 1-year period. The participants were scored based on window acquisition, quality of images, accuracy of FAST scan interpretation, confidence level rated by participant, and supervising attending physician. In phase 1, 68 novice medical students participated in 11 training sessions offered over a 1-year period. Students showed significant improvement in basic ultrasound and abdominal anatomy knowledge. The mean score improved from a pretest score of 5.8 of 10 (95% CI: 5.3-6.2) to a posttest score of 7.3 of 10 (95% CI: 7-7.6). The students also demonstrated a significant improvement in FAST image interpretation (pretest of 6.2 [95% CI: 5.9-6.6] and posttest of 7.6 [95% CI: 7.1-7.9]). In phase 2, 22 students performed 304 FAST examinations on patients. At the beginning of their training when they performed less than 10 FAST scans, students were able to complete the right upper quadrant view in 88.9%, left upper quadrant view in 69.7%, subxiphoid in 64.7%, and pelvic view in 70% of scans. Across all views of the FAST examination, increasing level of practice was associated with improvement in successfully completing the examination. The absolute increase in the proportion experiencing success in the right upper quadrant view was 1.6%, 3.6%, and 6.2% for the 10-19, 20-29, and >30 groups, respectively, of which none were statistically significant. However, the improvements in the left upper quadrant view was 12.7%, 11.6%, 15.7% for the 10-19, 20-29, and >30 groups, respectively. In all views, performing >30 examinations more than doubled the odds of successfully completing the examination. An experiential learning model of ultrasound training consisting of brief didactic presentation, practice FAST examinations on normal models, and proctored examinations on patients is an effective way to teach preclinical medical students basic ultrasound skills.

Abdominal Injuries in the “Found Down”: Is Imaging Indicated?

We sought to investigate the incidence of abdominal injuries in "found down" trauma patients to better understand the value of emergency department (ED) imaging. Found down patients are at high risk for injuries to the head or neck and low risk to the abdomen or pelvis, so imaging with CT of the abdomen/pelvis (AP) or Focused Assessment with Sonography for Trauma (FAST) is of questionable value. The trauma registry was queried over a 10-year period ending December 2013 for found down patients. Demographics, CT AP, FAST scans, and injuries were abstracted from the trauma registry and then through a confirmatory chart review. The primary outcome was significant abdominal or pelvis injury, defined as abdomen/pelvis Abbreviated Injury Scale (AIS) ≥ 3 or an abdominal injury that required operative intervention. The secondary outcome was mortality due to abdominal injury. Of the 342 patients who met inclusion criteria, mean Glasgow Coma Scale (GCS) was 11.0, and 189 (60%) of those tested for alcohol were intoxicated. Abdominal imaging included: CT AP only, 88 (57%); FAST only, 37 (24%); and CT AP and FAST, 29 (19%). Neither CT AP nor FAST scan led to a change in treatment and no patient had abdomen/pelvis AIS ≥ 3. Overall mortality was 33 (10%).The 24 trauma deaths were attributed to serious head trauma (n = 16) or traumatic arrest in the ED (n = 8); the 9 medical deaths were due to cerebral vascular accident (n = 5) or sepsis (n = 4). Although patients found down have a high mortality, abdominal injuries identified by imaging are highly unlikely. Efforts should focus on rapidly identifying and treating other causes of mortality, especially trauma to the head and neck, or medical diagnoses such as cerebral vascular accident or sepsis.

Focused Multiorgan Bedside Ultrasound in Patients with Nontraumatic Hypotension: A “Medical” FAST Scan?

Focused Assessment with Sonography for Trauma (FAST) is routinely used in the evaluation of trauma patients, yet has not been shown to be useful in