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Chest Abdominal-Focused Assessment Sonography for Trauma during the primary survey in the Emergency Department: the CA-FAST protocol

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Abstract

Purpose

To evaluate the feasibility of a new protocol, Chest Abdominal-Focused Assessment Sonography for Trauma (CA-FAST), during the primary survey and to estimate its diagnostic accuracy when compared with thoracoabdominal computed tomography (CT) scan.

Methods

A prospective accuracy study was performed from November 2012 to November 2013 at the Emergency Department. Only adult trauma patients who underwent a CA-FAST examination prior to a thoracoabdominal CT scan were enrolled. In addition to standard patterns detected by Extended-FAST (E-FAST) such as pneumothorax (PTX), hemothorax (HTX), pericardial and intraabdominal effusion, CA-FAST protocol also included the research of lung contusions (LCs).

Results

Six hundred and one patients were enrolled. The mean time for protocol execution was 7 ± 3 min. Chest ultrasonography showed the following results (all p < 0.001): LCs sensitivity 59 %, specificity 98 %, positive predictive value (PPV) 92 %, negative predictive value (NPV) 86 %, accuracy 87 %; PTX sensitivity 84 %, specificity 98 %, PPV 93 %, NPV 95 %, accuracy 95 %; HTX sensitivity 82 %, specificity 97 %, PPV 87 %, NPV 95 %, accuracy 94 %. The standard 4-views FAST examination showed a diagnostic accuracy of 91 % with a sensitivity of 75 %, specificity of 96 %, PPV of 81 % and NPV of 94 %.

Conclusion

According to our results CA-FAST protocol proved to be a rapid bedside method, with good accuracy and high NPV in detection of ultrasonographic patterns suggestive of serious injury in trauma patients; moreover, the additional research of LCs did not cause a delay in the diagnosis. Ultrasonography should be used as initial investigation during the primary survey, sending to further diagnostic studies (CT scan) only those patients not clearly classified.

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Abbreviations

FAST:

Focused Assessment Sonography for Trauma

CA-FAST:

Chest Abdominal-Focused Assessment Sonography for Trauma

CT:

Computed tomography

E-FAST:

Extended-FAST

PTX:

Pneumothorax

HTX:

Hemothorax

LCs:

Lung contusions

PPV:

Positive predictive value

NPV:

Negative predictive value

ED:

Emergency Department

ATLS:

Advanced trauma life support

US:

Ultrasonography

X-ray:

Radiography

EP:

Emergency physician

ISS:

Injury Severity Score

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Authors and Affiliations

  1. Emergency Department, Careggi University Hospital, Largo Brambilla, 3, 50134, Florence, Italy

    M. Zanobetti, A. Coppa, P. Nazerian, S. Grifoni, M. Scorpiniti, F. Innocenti, A. Conti, S. Bigiarini, S. Gualtieri, C. Casula, P. F. Ticali & R. Pini

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  1. M. Zanobetti
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Correspondence to M. Zanobetti.

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Conflict of interest

Maurizio Zanobetti, Coppa Alessandro, Nazerian Peiman, Grifoni Stefano, Scorpiniti Margherita, Innocenti Francesca, Conti Alberto, Bigiarini Sofia, Gualtieri Simona, Casula Claudia, Ticali Piero Francesco and Pini Riccardo declare that they have no conflict of interest.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Zanobetti, M., Coppa, A., Nazerian, P. et al. Chest Abdominal-Focused Assessment Sonography for Trauma during the primary survey in the Emergency Department: the CA-FAST protocol. Eur J Trauma Emerg Surg 44, 805–810 (2018). https://doi.org/10.1007/s00068-015-0620-y

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