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Focused Abdominal Sonogram for Trauma: The Learning Curve of Nonradiologist Clinicians in Detecting Hemoperitoneum

Shackford, Steven R. MD; Rogers, Frederick B. MD; Osler, Turner M. MD; Trabulsy, Mario E. MD; Clauss, David W. MD; Vane, Dennis W. MD

The Journal of Trauma: Injury, Infection, and Critical Care: April 1999 - Volume 46 - Issue 4 - p 553-564
Article: Presented At The 58Th Annual Meeting Of The American Association For The Surgery Of Trauma Meeting Jointly With The Trauma Association Of Canada, September 24-26, 1998, Baltimore, Maryland

Background The focused abdominal sonogram for trauma (FAST) has been used by surgeons and emergency physicians (CLIN) to screen reliably for hemoperitoneum after trauma. Despite recommendations for "appropriate training," ranging from 50 to 400 proctored examinations, there are no supporting data.

Methods We prospectively examined the initial FAST experience of CLIN in detecting hemoperitoneum by using diagnostic peritoneal lavage, computed tomography, and clinical findings as the diagnostic "gold standard."

Results 241 patients had FAST performed by 12 CLIN (average, 20/CLIN; range, 2-43); 51 patients (21.2%) had hemoperitoneum and 17 patients (7.1%) required laparotomy. Initial experience with FAST by CLIN produced 35 true positives, 180 true negatives, 16 false negatives, and 3 false positives; sensitivity, 68%; specificity, 98%. Initial error rate was 17%, which fell to 5% after 10 examinations ([chi squared]; p < 0.05).

Conclusion Previous recommendations for the number of proctored examinations for individual nonradiologist clinician sonographers to develop competence are excessive.

From the University of Vermont, Department of Surgery, Burlington, Vermont.

Presented at the 58th Annual Meeting of the American Association for the Surgery of Trauma and the Trauma Association of Canada, September 24-27, 1998, Baltimore, Maryland.

Address for reprints: Steven R. Shackford, MD, Department of Surgery, University of Vermon, Fletcher House 301, 111 Colchester Ave., Burlington, VT 05401; email:

© 1999 Lippincott Williams & Wilkins, Inc.