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The focused assessment with sonography in trauma (FAST) tool is used in blunt and penetrating trauma to determine whether surgery is necessary
The focused assessment with sonography in trauma (FAST) tool is used in blunt and penetrating trauma to determine whether surgery is necessary.
The main purpose of the FAST test is to detect the presence of free intraperitoneal fluid. Many life-threatening abdominal injuries result in internal bleeding, and ultrasound examination can identify intraperitoneal, pericardial, and pelvic hemorrhages. This is critical in deciding on whether unstable patients require surgery.
Because it can be potentially performed concurrently with other resuscitation modalities of care, ultrasound-guided FAST is the optimal initial imaging modality because it gives more essential information than radiography or computed tomography scanning.
The FAST test has been expanded to include an examination of the lungs to rule out the existence of hemothorax and pneumothorax in cases of chest trauma. It is now called extended focused assessment with sonography in trauma examination.
How reliable is the FAST trauma assessment tool?
Studies have shown that the FAST trauma assessment tool has:
- 90% sensitivity
- 99% specificity
- 99% accuracy
One of the reasons why the tool is reliable is because it includes four critical areas during screening:
- Intrathoracic abdomen (areas under the rib cage)
- Retro-peritoneal abdomen
- Kidneys
- Ureters
- Pancreas
- Abdominal aorta and inferior vena cava
- True abdomen
- Small intestine
- Large intestine
- Gravid uterus
- Distended urinary bladder
- Pelvic abdomen
- Urinary bladder
- Urethra
- Rectum
- Small intestine
- Ovaries
- Fallopian tubes
- Uterus
The FAST examination can be performed safely and quickly in any medical facility.
When is the FAST trauma assessment tool used?
The FAST trauma assessment tool is used in the following situations:
- Blunt trauma to the:
- Abdomen
- Heart
- Chest (extended focused assessment with sonography in trauma or EFAST examination)
- Penetrating trauma to the:
- Abdomen
- Heart
- Chest (EFAST)
- Ectopic pregnancy
What are the advantages of the FAST trauma assessment tool?
The FAST trauma assessment tool is extremely useful in the following conditions:
- Patient is in a state of shock, and the cause of the hypotension is unknown.
- Patient has trauma to the upper abdomen and lower chest.
- Patient has sustained injuries but has no obvious indications for a computed tomography (CT) scan.
- After surgery of a patient who has suffered abdominal or chest trauma and needs to be moved to a medical facility that does not have a trauma unit:
- If pericarditis is diagnosed by FAST examination, pericardiocentesis is performed.
- If a hemothorax and pneumothorax is found during the FAST evaluation, a chest tube is inserted.
The FAST trauma assessment tool is critical because it can help determine whether the patient should be transferred through aero-medical transport.
In unstable patients
- If the FAST examination results are positive, the patient should be taken to the operating room for a laparotomy.
- If the FAST test results are negative, other potential locations of blood loss should be examined. The FAST exam can be taken again later, or a diagnostic peritoneal lavage can be done.
In stable patients
- If the FAST examination results are positive, the patient should be referred to CT scanning to determine the source of the concealed bleeding.
- If the FAST examination results are negative, the following steps should be taken:
- Clinical observation
- Serial examinations
- Repeat fast examination
- CT scanning
FAST and EFAST examinations can be performed in an extremely short period of time by trained medical personnel and will provide an accurate result of the presence or absence of internal bleeding that occurred post trauma. This allows for faster decision-making on how to save the patient while at the scene of the accident, while being transported, or in the emergency room.
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What are the drawbacks of the FAST trauma assessment tool?
There are no known problems associated with the FAST trauma assessment tool. Ultrasound, however, has significant restrictions. It is only 85% sensitive, requiring more than 150-200 cc of intra-peritoneal fluid to detect. Serial FAST tests can help prevent false-negative studies.
- False-negatives: Patients with delayed presentations after trauma, where bleeding has stopped, often show a mixed echogenicity in ultrasonography rather than anechoic (black appearance of fresh blood or fluid).
- False-positives: Ascites, peritoneal dialysate, ruptured ovarian cysts, and ruptured ectopic pregnancies are examples of false positives.
Furthermore, with severe pelvic injuries, ultrasonography cannot differentiate between blood and urine and cannot assess retroperitoneal hemorrhages. Most importantly, the point of care ultrasound image acquisition and interpretation is limited by the provider’s experience. Serial exams and advanced imaging are warranted in these situations based on the patient’s hemodynamic status.
The FAST test is highly specific for use in intra-abdominal trauma and beneficial for hemodynamically unstable patients.
