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Residents Should Not Independently Perform Focused Abdominal Sonography for Trauma After 10 Training Examinations

Division of Emergency Medicine, Washington University, School of Medicine, St Louis, Missouri USA.

Address correspondence and reprint requests to Timothy Jang, MD, Division of Emergency Medicine, Barnes-Jewish Hospital, Campus Box 8072, St Louis, MO 63110 USA. E-mail: jangt{at}msnotes.wustl.edu.

Objectives. To assess whether 10 focused abdominal sonography for trauma (FAST) examinations could be used as a minimum standard for training, as suggested previously. Methods. This was a retrospective review of patients with abdominal trauma who underwent resident-performed FAST examinations before surgical or Department of Radiology evaluation. Results. Six hundred ninety-eight patients were examined by resident-performed FAST followed by reference standard evaluations. Four hundred twelve patients were evaluated by residents who previously performed 10 FAST examinations; 154 were evaluated by 29 residents performing their 11th through 30th examinations; and 258 were evaluated by 10 residents performing their 31st and subsequent examinations. The results of resident-performed FAST for intraperitoneal free fluid were as follows: 11 to 20 examinations—sensitivity, 73.9% (95% confidence interval, 51.3%–88.9%); specificity, 98.8% (92.5%–99.9%); true-positive findings, 17; true-negative, 81; false-positive, 1; false-negative, 6; total patients, 105; 21 to 30 examinations—sensitivity, 100% (73.2%–100%); specificity, 97.1% (83.3%–99.9%); true-positive, 14; true-negative, 34; false-positive, 1; false-negative, 0; total patients, 49; 31 and more examinations—sensitivity, 94.8% (88.6%–97.9%); specificity, 98.6% (94.5%–99.8%); true-positive, 110; true-negative, 140; false-positive, 2; false-negative, 6; total patients, 258. Conclusions. The suggestion that 10 examinations could be used as a minimum standard for training in FAST examinations was not validated.

Key Words: focused abdominal sonography for trauma • resident • training standard • ultrasound education

Abbreviations: CT, computed tomography • ED, emergency department • EP, emergency physician • FAST, focused abdominal sonography for trauma • FF, free fluid

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