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FAST Exam Versus CT Scan in the Diagnosis of Interperitoneal Injury in a Hemodynamically Stable Patient With Blunt Abdominal Trauma: A Systematic Review.

7 February 2011

Abstract

Background: The FAST exam is a tool that trauma physicians can use to evaluate patients with blunt trauma and possible abdominal injury. Currently, FAST has become the method of choice in evaluating hemodynamically unstable patients due to the rapid determination of any life-threatening abdominal injuries. The question that remains is the value of the FAST exam in hemodynamically stable blunt abdominal trauma patients. The evidence was evaluated using GRADE, which was developed to help health care professionals determine the quality of evidence and strength of recommendations presented in studies.

Method: An extensive literature search was performed using Medline, CINAHL, Cochrane

Systematic Reviews, PubMed, and Web of Science. The search was limited to human subjects, the English language, and articles published since the last systematic review in 2009.

Results: Three studies were included in this systematic review. For this review, the sensitivity for the FAST exam in detecting free fluid was variable across all three studies; however, the specificity, positive predictive value, and negative predictive value were consistent and greater than 88% throughout the studies.

Conclusion: Given the above results, the overall GRADE of evidence was upgraded from low to moderate. Since the sensitivity of the FAST exam was variable throughout the studies, the final conclusion of this systematic review is to continue using CT scan after blunt abdominal trauma to avoid missing any potential life-threatening injuries. A large mutlicenter trial would be useful in evaluating the effectiveness of FAST in hemodynamically stable blunt trauma patients.

Keywords: Abdominal injury, FAST exam, ultrasonography, CT scan.


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