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

doi:10.1016/S0020-1383(02)00017-7

Injury

Volume 33, Issue 4, May 2002, Pages 303-308

https://doi.org/10.1016/S0020-1383(02)00017-7 Get rights and content

Abstract

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.

Introduction

A quick sonographic screen to quickly identify the presence of free intra-peritoneal and intra-pericardial fluid constitutes the focused assessment with sonography for trauma (FAST) scan [1]. The most important of the benefits that this technique provides is an earlier and portable means of confirming the presence of intra-cavity hemorrhage. Any device that has the ability to detect the source of hemorrhage quicker may have an impact on saving lives. The Australasian Trauma Society has formally recognized this and has stated that emergency sonography should be immediately available to all victims of traumatic injury (www.trauma.org/ats/ultrasound.html).

Portable hand-held ultrasound units have recently become available to clinicians. These units were developed through a joint civilian–military initiative to provide a portable ultrasound capability suitable for the battlefield or mass casualty situation [2]. A recent international consensus conference stressed the general importance of examining the potential role of smaller, compact portable ultrasound machines in the early diagnosis of traumatic abdominal injury [1]. Initial reports on these devices have supported their use for performing early screening exams [3], [4], [5]. This manuscript reports the effectiveness of the use of a portable 2.4 kg hand-held ultrasound machine in the resuscitations of trauma patients at an urban level-I trauma center. The goal of this study was to determine the effectiveness of using a portable hand-held ultrasound unit during emergency trauma resuscitations. The performance of this device in the hands of a clinician was compared to the performance of a standard floor based ultrasound unit that had previously served as that institution’s initial screening tool for both blunt and penetrating thoraco-abdominal injuries.

Section snippets

Materials and methods

The Detroit Receiving Hospital is an urban level-I University trauma center. A trauma team carries out the resuscitation and evaluation of all seriously injured trauma victims. A FAST examination is the initial imaging examination performed after the primary survey of the physical examination, and is routinely done by either the attending surgeons or surgical house staff. The exam is performed on all victims of; isolated blunt abdominal trauma; multi-system blunt trauma; penetrating wounds of

Results

Seventy-one patients were entered in the study. Fifty-eight victims of blunt trauma and 13 victims of penetrating trauma were examined early in the course of trauma resuscitations. The patients comprised 57 males and 14 females, with an average injury severity score (ISS) of 9.8 (S.D.=8.7). Eleven (15.5%) were victims of gunshot wounds, and two (2.8%) were stabbed. Twenty-eight (39%) were injured as a result of being occupants involved in motor vehicle crashes (MVCs), 11 (15.4%) from being

Discussion

This study evaluated the performance of a hand-held ultrasound examination for expedited clinician-performed FAST examinations in the early phases of trauma resuscitations. Physical findings in the multiply injured are often unreliable, because of the neurologic status, the presence of analgesic, sedative, and other psychotropic medications, and other distracting injuries [8], [9], therefore, a quick non-invasive, and repeatable screening test is valuable [10], [11]. The accurate utilization of

Conclusion

Hand-held portable ultrasound units can be used effectively by appropriately trained clinicians involved in trauma care under real-life conditions to quickly detect intra-peritoneal fluid with a high degree of accuracy. No single technique or device will always perform flawlessly in all situations but the hand-held ultrasound is a safe, relatively cheap, and dependable device that does not compromise the patients future examinations, nor carry the risks of ionizing radiation. Conversely, this

Acknowledgments

Kathy Rishell, Trauma Program Coordinator and Karla R Price Trauma Program Specialist, Detroit Receiving Hospital and University Health Center, Detroit, Michigan. Joanne Clifton, BSC, Department of Surgery, Vancouver Hospital and Health Sciences Center, Vancouver, British Columbia. The Sonosite Corporation, Bothell, Washington, for the generous donation of the Sonosite™ 180 ultrasound unit for clinical testing.

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^☆: The authors have received no financial or administrative support other than the trial use of a Sonosite™ 180 ultrasound device from the Sonosite Corporation for testing. This manuscript has been referenced using Procite 4.0 Reference Manager. This manuscript was presented at the joint meeting of the Australasian Trauma Society and the Trauma Association of Canada, Sydney, Australia, 3 March 2001.

View full text

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

Abstract

Introduction

Section snippets

Materials and methods

Results

Discussion

Conclusion

Acknowledgments

Cardiovasc. Surg.

Am. J. Emerg. Med.

Injury

Surg. Clin. North Am.

Surg. Clin. North Am.

Focused assessment with sonography for trauma (FAST): results from an international consensus conference

J. Trauma

Comparison of a hand-held portable ultrasound instrument to standard ultrasound for emergency department FAST exam [abstract]

J. Trauma

Portable hand-held sonography utilized for the focussed assessment with sonography for trauma: a pilot study [abstract]

Crit. Care Shock

Digital hand-held sonography utilized for the focused assessment with sonography for trauma: a pilot study

Ann. Acad. Med. Singapore

The indeterminate abdominal sonogram in multi-system blunt trauma

J. Trauma

1000 consecutive ultrasounds for blunt abdominal trauma

J. Trauma

Unrecognized abdominal trauma in patients with head injuries

Ann. Surg.

Recognition of intra-abdominal injury in blunt trauma victims

Am. Surg.

Blunt abdominal trauma in cases of multiple trauma evaluated by ultrasonography: prospective analysis of 291 patients

J. Trauma

Ultrasound based key clinical pathway reduces the use of hospital resources for the evaluation of blunt abdominal trauma

J. Trauma

Focused abdominal US in patients with trauma

Radiology

Sonography in a clinical algorithm for early evaluation of 1671 patients with blunt abdominal trauma

Am. J. Roentgenol.

Prospective analysis of a rapid trauma ultrasound examination performed by emergency physicians

J. Trauma

Ultrasound training for emergency physicians-a prospective study

Acad. Emerg. Med.

Sonography in blunt abdominal trauma: a preliminary progress report

J. Trauma

Ultrasonography in blunt abdominal trauma: influence of the investigators experience

J. Trauma