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Case 53 - False-negative and False-positive FAST

from Section 5 - Abdomen

Published online by Cambridge University Press:  05 March 2013

By
Martin L. Gunn
Edited by
Martin L. Gunn
Martin L. Gunn
Affiliation:
University of Washington School of Medicine
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Summary

Imaging description

Focused assessment with sonography for trauma (FAST) is an adjunct to the American College of Surgeons’ Advanced Trauma Life Support (ATLS) primary survey.

Unfortunately, there are very few prospective randomized trials that examine the efficacy and effectiveness of FAST on patients with blunt abdominal trauma [1]. Multiple retrospective studies have generally demonstrated a high specificity (≥95%), but widely ranging sensitivity (43–89%) for the detection on free intraperitoneal fluid [2–5]. Consequently, a negative FAST examination should not be considered as a means of excluding significant abdominal injury, especially in the hemodynamically stable patient. Moreover, FAST has not been shown to conclusively reduce the rate of trauma laparotomy or diagnostic peritoneal lavage (DPL), although it might lead to a slight reduction in the rate of CT scanning [1]. Limited data suggest a follow-up FAST scan might increase sensitivity [6, 7]. However, if there is a high pre-test probability of an abdominal injury, contrast-enhanced CT should be considered [1] following a negative FAST.

Type
Chapter
Information
Pearls and Pitfalls in Emergency Radiology
Variants and Other Difficult Diagnoses
 , pp. 175 - 178
Publisher: Cambridge University Press
Print publication year: 2013

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References

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