Algorithm of Boulanger et al for Use of the FAST Examination in the Assessment of Blunt Abdominal Injury

 

Sites examined:

(1) subxyphoid pericardium

(2) left upper quadrant

(3) right upper quadrant (Morison's pouch between liver and right kidney)

(4) pelvis (suprapubic)

 

Patient selection: blunt trauma victim with suspicion of abdominal injury

FAST Examination	Clinical Status	Decision
positive for free fluid	stable	perform CT scan
positive for free fluid	unstable	exploration
indeterminate		repeat FAST, DPL or CT examination
negative for free fluid	stable	follow-up (observe)
negative for free fluid	unstable	perform repeat FAST

 

where:

• I would imagine that clinical status would affect the decision making with an indeterminate FAST examination.

• The choice of test after an indeterminate FAST examination would depend on the why the test was considered indeterminate. It might be reasonable to go to CT scan if something was present that is a known limiting factor for a FAST examination.

• Mirvis et al include a repeat FAST examination during the observation period in patients with a negative FAST exam who are clinically stable.

 

Performance:

• In the series of Boulanger et al, the sensitivity of the FAST examination was 96% with specificity 99.7%, positive predictive value of 98.7%, negative predictive value of 99.2% and accuracy 99.1%.

• This compared with a non-FAST protocol that had a sensitivity of 92.6%, specificity of 99.5%, positive predictive 98%, negative predictive value 97.9% and accuracy 98%.