The accuracy of FAST in relation to grade of solid organ injuries: A retrospective analysis of 226 trauma patients with liver or splenic lesion

A retrospective analysis of 226 multiply injured patients with liver or splenic lesions treated at Bern University Hospital, Switzerland.FAST failed to detect free fluid or organ lesions in 45 of 226 patients with spleen or liver injuries (sensitivity 80.1%). Overall specificity was 99.5%. The positive and negative predictive values were 99.4% and 83.3%. The overall likelihood ratios for a positive and negative FAST were 160.2 and 0.2. Grade III-V organ lesions were detected more frequently than grade I and II lesions. Without the additional diagnostic accuracy of a CT scan, the mean ISS of the FAST-false-negative patients would be significantly underestimated and 7 previously unsuspected intra-abdominal injuries would have been missed.FAST is an expedient tool for the primary assessment of polytraumatized patients to rule out high grade intra-abdominal injuries. However, the low overall diagnostic sensitivity of FAST may lead to underestimated injury patterns and delayed complications may occur. Hence, in hemodynamically stable patients with abdominal trauma, an early CT scan should be considered and one must be aware of the potential shortcomings of a "negative FAST".A fast diagnostic workup with high accuracy is an important prerequisite for the successful management of patients with multiple injuries [1]. The acronym "FAST" (Focused Assessment with Sonography for Trauma) first appeared in 1995 and the detailed technique was defined at the International Consensus Conference, 1997 as real-time sonographic scanning for free fluid in 4 distinct regions of the torso: the pericardial, perihepatic, perisplenic, and pelvic regions (2, 3). FAST has reached worldwide importance through its incorporation into the algorithms of Advanced Trauma Live Support？ (ATLS？) [2]. But, the role of FAST must be continuously reassessed because, despite its high specificity, ultrasonography (US) has a low sensitivity ranging from 40–80% for the detection of free fluid and particularly of