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Open Access Research article

The accuracy of FAST in relation to grade of solid organ injuries: A retrospective analysis of 226 trauma patients with liver or splenic lesion

Beat Schnüriger1*, Joachim Kilz2, Daniel Inderbitzin1, Miranda Schafer1, Ralph Kickuth3, Martin Luginbühl4, Daniel Candinas1, Aristomenis K Exadaktylos2 and Heinz Zimmermann2

Author Affiliations

1 Department of Visceral and Transplantation Surgery, Bern University Hospital, Bern, Switzerland

2 Department of Trauma and Emergency Medicine, Bern University Hospital, Bern, Switzerland

3 Department of Diagnostic, Interventional and Pediatric Radiology, Bern University Hospital, Bern, Switzerland

4 Department of Anaesthesia, Bern University Hospital, Bern, Switzerland

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BMC Medical Imaging 2009, 9:3  doi:10.1186/1471-2342-9-3

Published: 26 March 2009

Abstract

Background

This study investigated the role of a negative FAST in the diagnostic and therapeutic algorithm of multiply injured patients with liver or splenic lesions.

Methods

A retrospective analysis of 226 multiply injured patients with liver or splenic lesions treated at Bern University Hospital, Switzerland.

Results

FAST failed to detect free fluid or organ lesions in 45 of 226 patients with spleen or liver injuries (sensitivity 80.1%). Overall specificity was 99.5%. The positive and negative predictive values were 99.4% and 83.3%. The overall likelihood ratios for a positive and negative FAST were 160.2 and 0.2. Grade III-V organ lesions were detected more frequently than grade I and II lesions. Without the additional diagnostic accuracy of a CT scan, the mean ISS of the FAST-false-negative patients would be significantly underestimated and 7 previously unsuspected intra-abdominal injuries would have been missed.

Conclusion

FAST is an expedient tool for the primary assessment of polytraumatized patients to rule out high grade intra-abdominal injuries. However, the low overall diagnostic sensitivity of FAST may lead to underestimated injury patterns and delayed complications may occur. Hence, in hemodynamically stable patients with abdominal trauma, an early CT scan should be considered and one must be aware of the potential shortcomings of a "negative FAST".