A Comparative Analysis of Diagnostic Accuracy of Focused Assessment With Sonography for Trauma Performed by Emergency Medicine and Radiology Residents

Abstract

Background: Focused assessment with sonography in trauma (FAST) is a method for prompt detection of the abdominal free fluid in patients with abdominal trauma. Objectives: This study was conducted to compare the diagnostic accuracy of FAST performed by emergency medicine residents (EMR)and radiology residents (RRs) in detecting peritoneal free fluids. Patients and Methods: Patients triaged in the emergency department with blunt abdominal trauma, high energy trauma, and multiple traumas underwent a FAST examination by EMRs and RRs with the same techniques to obtain the standard views. Ultrasound findings for free fluid in peritoneal cavity for each patient (positive/negative) were compared with the results of computed tomography, operative exploration, or observation as the final outcome. Results: A total of 138 patients were included in the final analysis. Good diagnostic agreement was noted between the results of FAST scans performed by EMRs and RRs (kappa = 0.701, P < 0.001), also between the results of EMRs-performed FAST and the final outcome (kappa = 0.830, P < 0.0010), and finally between the results of RRs-performed FAST and final outcome (kappa = 0.795, P < 0.001). No significant differences were noted between EMRs- and RRs-performed FASTs regarding sensitivity (84.6 vs 84.6), specificity (98.4 vs 97.6), positive predictive value (84.6 vs 84.6), and negative predictive value (98.4 vs 98.4). Conclusions: Trained EMRs like their fellow RRs have the ability to perform FAST scan with high diagnostic value in patients with blunt abdominal trauma.