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FAST (Focused Assessment With Sonography in Trauma) Accurate for Cardiac and Intraperitoneal Injury in Penetrating Anterior Chest Trauma

Department of Emergency Medicine (V.S.T., M.A.B., J.A.M., C.A.T.), and Department of Surgery, Trauma Division (M.H.T.), Carolinas Medical Center, Charlotte, North Carolina USA.

Address correspondence and reprint requests to Vivek Tayal, MD, Department of Emergency Medicine, Carolinas Medical Center, Box 32861, Charlotte, NC 28232 USA. E-mail: vtayal{at}carolinas.org.

Objective. To evaluate the FAST (focused assessment with sonography in trauma) examination for determining traumatic pericardial effusion and intraperitoneal fluid indicative of injury in patients with penetrating anterior chest trauma. Methods. An observational prospective study was conducted over a 30-month period at an urban level I trauma center. FAST was performed in the emergency department by emergency physicians and trauma surgeons. FAST results were recorded before review of patient outcome as determined by 1 or more of the following: thoracotomy, laparotomy, pericardial window, cardiologic echocardiography, diagnostic peritoneal lavage, computed tomography, and serial examinations. Results. FAST was undertaken in 32 patients with penetrating anterior chest trauma: 20 (65%) had stab wounds, and 12 (35%) had gunshot wounds. Sensitivity of FAST for cardiac injury (n = 8) in patients with pericardial effusion was 100% (95% confidence interval, 63.1%–100%); specificity was 100% (95% confidence interval, 85.8%–100%). The presence of pericardial effusion determined by FAST correlated with the need for thoracotomy in 7 (87.5%) of 8 patients (95% confidence interval, 47.3%–99.7%). One patient with a pericardial blood clot on cardiologic echocardiography was treated nonsurgically. FAST had 100% sensitivity for intraperitoneal injury (95% confidence interval, 63.1%–100%) in 8 patients with views indicating intraperitoneal fluid but without pericardial effusion, again with no false-positive results, giving a specificity of 100% (95% confidence interval, 85.8%–100%). This prompted necessary laparotomy in all 8. Conclusions. In this series of patients with penetrating anterior chest trauma, the FAST examination was sensitive and specific in the determination of both traumatic pericardial effusion and intraperitoneal fluid indicative of injury, thus effectively guiding emergent surgical decision making.

Key Words: cardiac • chest • FAST • focused assessment with sonography in trauma • intraperitoneal • injury • pericardial effusion • trauma

Abbreviations: CI, confidence interval • CT, computed tomography • FAST, focused assessment with sonography in trauma • IP, intraperitoneal • PE, pericardial effusion

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