Diagnostic Accuracy of Focused Assessment with Sonography for Trauma (FAST) Examinations Performed by Emergency Medical Technicians
Prehospital Emergency Care, 06/15/2012
Kim CH et al. – Emergency medical technicians (EMTs) in Korea showed a high diagnostic performance that was comparable to that of surgeons and physicians when detecting peritoneal cavity free fluid in a Korean emergency department setting.Methods
- Six level 1 EMTs (similar to intermediate EMTs in the United States) who worked at a tertiary emergency department in Korea underwent an educational program consisting of two one-hour didactic lectures that included the principles of ultrasonography, the anatomy of the abdomen, and two hours of hands-on practice.
- After this educational session, the EMTs performed FAST examinations on a convenience sample of patients from July 1 to October 5, 2009.
- These patients also received an abdominal computed tomography (CT) scan regardless of their chief complaints.
- The CT findings served as the definitive standard and were interpreted routinely and independently by emergency radiologists who were blinded to the study protocol.
- In addition, the EMTs were blinded to the CT findings.
- A positive CT finding was defined as the presence of free fluid, as interpreted by the radiologist.
- The sensitivity, specificity, predictive values, and their 95% confidence intervals (CIs) were calculated.
- Informed consent was obtained from all participating patients.
- Among the 1,060 eligible patients with abdominal CT scans, 403 patients were asked to participate in the study, and 240 patients agreed.
- Of these 240 patients, 80 (33.3%) had results showing the presence of free fluid.
- Fourteen patients had a significant amount of peritoneal cavity fluid, 15 had a moderate amount of peritoneal cavity fluid, and 51 had a minimal amount of peritoneal cavity fluid.
- Compared with the CT findings, the diagnostic performance of the FAST examination had a sensitivity of 61.3% (95% CI, 50.3%-71.2%), specificity of 96.3% (95% CI, 92.1%-98.3%), positive predictive value of 89.1% (95% CI, 77.0%-95.4%), and negative predictive value of 83.2% (95% CI, 76.9%-88.2%).
- For a significant or moderate amount of peritoneal cavity fluid, the sensitivity was considerably higher (86.2%).