TITLE: Ultrasound, what every trauma surgeon should know
SOURCE: J Trauma 1996 Jan;40(1):1-4
AUTHORS: Rozycki GS; Shackford SR
"Recent data have conclusively shown that skepticism regarding the accuracy of ultrasound is unfounded. Ultrasonography has been shown to be as accurate as DPL and CT in the detection of hemoperitoneum following abdominal trauma."
It is now well established that surgeons can perform a focused abdominal ultrasound for trauma (FAST) as accurately as formally trained radiologists. In a collected series of 4,941 patients, surgeons performed FAST with a sensitivity of 93.4%, a specificity of 98.7% and an accuracy of 97.5% in detecting both hemoperitoneum and visceral injury."
Also see CURRENT OPINION "Postinjury Torso Ultrasound: FAST Should Be SLOH"; Walter L. Biffl, MD, Ernest E. Moore, MD, and John Kendall, MD; The Journal of Trauma: Injury, Infection, and Critical Care; Vol. 48, No. 4, April 2000
FAST may be false negative with intraperitoneal fluid accumulations of less than 600 cc. The learning curve for the procedure and accurate interpretation is 100 cases. Radiologists would disagree that an abdominal ultrasound can be carefully obtained and interpreted in 3 minutes (a commonly reported exam time). Small changes in probe position can make a difference in detecting abnormal intra-abdominal or intrathoracic fluid.
Authors recommend more deliberate, systematic and repeated FAST examinations, i.e.:
"In conclusion, we believe that a search for truncal injury should not be a "FAST" (Focused Abdominal Sonogram for Trauma) examination. Thus, we propose a new acronym for the sonographic assessment of trauma patients:
Systematic Look for Occult Hemorrhage (SLOH).
The use of this acronym will serve as a constant reminder to trauma surgeons and emergency physicians that accuracy is critical in maximizing the utility of the test as well as optimizing patient care."