A Focused Assessment with Sonography for Trauma (FAST) can be used to evaluate a patient with blunt abdominal trauma. Boulanger et al used an algorithm for use of FAST in conjunction with the patient's clinical status.


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


positive for free fluid


perform CT scan

positive for free fluid





repeat FAST, DPL or CT examination

negative for free fluid


follow-up (observe)

negative for free fluid


perform repeat FAST



• 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.



• 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%.


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