The hand-held FAST: experience with hand-held trauma sonography in a level-I urban trauma center.

AIMS To describe the effectiveness of a portable hand-held ultrasound machine when used by clinicians in the early evaluation and resuscitation of trauma victims. METHODS The study was a prospective evaluation in a level-I urban trauma center. The focussed assessment with sonography for trauma is a specifically defined examination for free fluid known as the focused assessment with sonography for trauma (FAST) exam. Seventy-one patients had a hand-held FAST (HHFAST) examination performed with a Sonosite 180, 2.4 kg ultrasound machine. Sixty-seven examinations were immediately repeated with a Toshiba SSH 140A portable floor-based machine. This repeat scan (formal FAST or FFAST) was used as a comparison standard between the devices for study purposes. Four patients had a HHFAST only, all with positive result, two being taken for immediate laparotomy, and two having a follow-up computed tomographic (CT) scan. Patient follow-up from other imaging studies, operative intervention, and clinical outcomes were also compared to the performance of each device. RESULTS There were 58 victims of blunt, and 13 of penetrating abdominal trauma. One examination was indeterminate using both machines. The apparent HHFAST performance yielded; sensitivity, specificity, positive predictive value, negative predictable value, and accuracy (S, S, PPV, NPV, A) of 83, 100, 100, 98, 98%. Upon review, a CT scan finding and benign clinical course found the HHFAST diagnosis to be correct rather than the FFAST in one case. Considering the ultimate clinical course of the patients, yielded a (S, S, PPV, NPV, A) of 78, 100, 100, 97, and 97% for the HHFAST and 75, 98, 86, 97, and 96% for the FFAST. Statistically, there was no significant difference in the actual performance of the HHFAST compared to the FFAST in this clinical setting. DISCUSSION Hand-held portable sonography can simplify early and accurate performance of FAST exams in victims of abdominal trauma.

[1]  J. Sehouli,et al.  Discriminatory power of 3.5 MHz convex and 7.5 MHz linear ultrasound probes for the imaging of traumatic splenic lesions: a feasibility study. , 2001, The Journal of trauma.

[2]  W. Chiu,et al.  Abdominal injuries without hemoperitoneum: a potential limitation of focused abdominal sonography for trauma (FAST) , 1997, The Journal of trauma.

[3]  R M Satava,et al.  Surgery 2001 , 1993, Surgical Endoscopy.

[4]  A. Buckley,et al.  Focused abdominal US in patients with trauma. , 2000, Radiology.

[5]  J R Mateer,et al.  Prospective analysis of a rapid trauma ultrasound examination performed by emergency physicians. , 1995, The Journal of trauma.

[6]  J. McGahan,et al.  Sonographic detection of blunt hepatic trauma: hemoperitoneum and parenchymal patterns of injury. , 1999, The Journal of trauma.

[7]  A. Hassn,et al.  Treatment with low molecular weight heparin needs anticoagulation monitoring. , 1999, Journal of the American College of Surgeons.

[8]  M. Rothmund,et al.  Ultrasonography in blunt abdominal trauma: influence of the investigators' experience. , 1993, The Journal of trauma.

[9]  G. Rozycki,et al.  Sonographic assessment of traumatic injury. Future developments. , 1999, The Surgical clinics of North America.

[10]  B. Boulanger,et al.  Utilization of FAST (Focused Assessment with Sonography for Trauma) in 1999: Results of a Survey of North American Trauma Centers , 2000, The American surgeon.

[11]  T. Scalea,et al.  Role of ultrasonography in penetrating abdominal trauma: a prospective clinical study. , 2001, The Journal of trauma.

[12]  J. McGahan,et al.  Ultrasound detection of blunt splenic injury. , 2001, Injury.

[13]  B. Boulanger,et al.  Hypotension after blunt abdominal trauma: the role of emergent abdominal sonography in surgical triage. , 1996, The Journal of trauma.

[14]  T. Scalea,et al.  Focused Assessment with Sonography for Trauma (FAST): results from an international consensus conference. , 1999, The Journal of trauma.

[15]  Shaun B. Jones,et al.  Preparing surgeons for the 21st century. Implications of advanced technologies. , 2000, The Surgical clinics of North America.

[16]  R. Satava.  Emerging technologies for surgery in the 21st century. , 1999, Archives of surgery.

[17]  S. Cantrill,et al.  Ultrasound based key clinical pathway reduces the use of hospital resources for the evaluation of blunt abdominal trauma. , 1997, The Journal of trauma.

[18]  B. Boulanger,et al.  Sonography in blunt abdominal trauma: a preliminary progress report. , 1991, The Journal of trauma.

[19]  G. Wetscher,et al.  Ultrasonography in the management of blunt abdominal and thoracic trauma. , 1994, Archives of surgery.

[20]  G. Rozycki,et al.  An algorithm to reduce the incidence of false-negative FAST∗ ∗ examinations in patients at high risk for occult injury 1 , 1999 .

[21]  J. D. Polk,et al.  The "Airmedical F.A.S.T." for trauma patients--the initial report of a novel application for sonography. , 2001, Aviation, space, and environmental medicine.

[22]  G. Regel,et al.  Blunt abdominal trauma in cases of multiple trauma evaluated by ultrasonography: a prospective analysis of 291 patients. , 1992, The Journal of trauma.

[23]  H. Shih,et al.  Ultrasonography for the evaluation of hemoperitoneum during resuscitation: a simple scoring system. , 1994, The Journal of trauma.

[24]  N. Aikawa,et al.  Usefulness and limitations of ultrasonography in the initial evaluation of blunt abdominal trauma. , 1997 .

[25]  D. R. Brown,et al.  Digital hand-held sonography utilised for the focused assessment with sonography for trauma: a pilot study. , 2001, Annals of the Academy of Medicine, Singapore.

[26]  G. Rozycki,et al.  Surgeon-performed ultrasound for the assessment of truncal injuries: lessons learned from 1540 patients. , 1998, Annals of surgery.

[27]  Bruce W. Thomas,et al.  Early detection of hemoperitoneum by Ultrasound examination of the right upper quadrant : A multicenter study , 1998 .

[28]  D. Mandavia,et al.  Ultrasound training for emergency physicians--a prospective study. , 2000, Academic emergency medicine : official journal of the Society for Academic Emergency Medicine.

[29]  G. Rozycki,et al.  Ultrasound, what every trauma surgeon should know. , 1996, The Journal of trauma.

[30]  A. Hagiwara,et al.  Hyperechoic appearance of hepatic parenchyma on ultrasound examination of patients with blunt hepatic injury. , 1998, The Journal of trauma.

[31]  T. Gaeta,et al.  A preliminary evaluation of emergency ultrasound in the setting of an emergency medicine training program. , 2000, The American journal of emergency medicine.

[32]  G. Rozycki,et al.  Prospective evaluation of surgeons' use of ultrasound in the evaluation of trauma patients. , 1993, The Journal of trauma.

[33]  B. Boulanger,et al.  The indeterminate abdominal sonogram in multisystem blunt trauma. , 1998, The Journal of trauma.

[34]  D. Nunez,et al.  1,000 consecutive ultrasounds for blunt abdominal trauma. , 1996, The Journal of trauma.

[35]  G Graschew,et al.  Telemedicine: the new must for surgery. , 1999, Archives of surgery.

[36]  A. V. van Vugt,et al.  Sonography in a clinical algorithm for early evaluation of 1671 patients with blunt abdominal trauma. , 1999, AJR. American journal of roentgenology.

[37]  B. Boulanger,et al.  Emergent abdominal sonography as a screening test in a new diagnostic algorithm for blunt trauma. , 1996, The Journal of trauma.

[38]  C. Wilson,et al.  Unrecognized Abdominal Trauma in Patients with Head Injuries , 1965, Annals of surgery.

[39]  D. Wherry.  Potential of a hand-held ultrasound in assessment of the injured patient. , 1998, Cardiovascular surgery.