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Validation of the quality of ultrasound imaging and competence (QUICk) score as an objective assessment tool for the FAST examination

Ziesmann, Markus Tyler MD, MSc; Park, Jason MD, MEd; Unger, Bertram J. MD, PhD; Kirkpatrick, Andrew W. MD, MHSc; Vergis, Ashley MD, MMedEd; Logsetty, Sarvesh MD; Pham, Chau MD, MBA; Kirschner, David MD; Gillman, Lawrence M. MD, MMedEd

Journal of Trauma and Acute Care Surgery: May 2015 - Volume 78 - Issue 5 - p 1008–1013
doi: 10.1097/TA.0000000000000639
Original Articles

BACKGROUND The Focused Assessment with Sonography for Trauma (FAST) examination has become a valuable tool in trauma resuscitation. Despite the widespread use of FAST training among traumatologists, no evidence-based guidelines exist to support optimal training requirements or to provide quantitative objective assessments of imaging capabilities. Both Task-Specific Checklist (TSC) and Global Rating Scale (GRS) have been validated as objective skill assessment tools; we developed both types of scoring checklist and assessed them for construct validity with the FAST examination.

METHODS Two scoring checklists, collectively termed the Quality of Ultrasound Imaging and Competence (QUICk) Score, were developed and subjected to a modified Delphi consensus process. Two cohorts of 12 novice and 12 expert sonographers performed the FAST examination and were evaluated by two experts according to the QUICk model. Total scores as well as anatomic subsets were compared via comparison of means, and logistic regression modeling was used to determine sensitivity and specificity.

RESULTS Experts achieved significantly higher total scores than novices on both scoring systems (17.2 vs. 11.1 of 24, p < 0.01 TSC, 29.8 vs. 18.4 of 40, p < 0.01 GRS). Sensitivity (85.7% TSC, 92.9% GRS) and specificity (75.0% TSC, 91.7% GRS) as well as area under the receiver operating characteristic curve (89.9% TSC, 97.6% GRS) were consistent with a highly discriminant tool.

CONCLUSION The QUICk Score is the first validated objective tool for assessment of the quality of FAST examination imaging. Use of this tool may be instrumental in developing an evidence-based minimum-performance standard and for assessing quality-improvement modifications in FAST examination training.

From the University of Manitoba, Winnipeg, Manitoba, Canada.

Submitted: October 3, 2014, Revised: January 4, 2015, Accepted: January 13, 2015.

Presented as a poster at the 73rd annual meeting of the American Association for the Surgery of Trauma, September 9–13, 2014, in Philadelphia, Pennsylvania.

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Address for reprints: Markus T. Ziesmann, MD, MSc, 20 Seaside Dr., Winnipeg, Manitoba, Canada R2J 3R7; email:

© 2015 Lippincott Williams & Wilkins, Inc.