Prospective evidence of the superiority of a sonography-based algorithm inthe assessment of blunt abdominal injury

Background: Although the routine use of FAST (focused assessment with sonog raphy for trauma) in the evaluation of trauma victims is increasing, to our knowledge, a prospective comparison of contemporary adult trauma victims m anaged with and without FAST has not been reported in North America, Methods: Adult victims of blunt trauma for whom there was a suspicion of ab dominal injury were managed with one of two diagnostic algorithms, FAST or no-FAST. The two algorithms were compared for diagnostic accuracy, cost, ti me, and delayed diagnoses. Results: Among 706 patients (mean Injury Severity Score, 23), 460 were mana ged with FAST and 246 with no-FAST. The two groups were similar with respec t to age, Injury Severity Score, prehospital time, and mortality (p = not s ignificant). There were 3 of 460 (0.7%) delayed diagnoses in the FAST group and 4 of 246 (1.6%) in the no-FAST group (p = not significant). The diagno stic accuracy for the FAST and no-FAST algorithms was 99% and 98%, respectf ully, The FAST and no-FAST algorithms led to similar rates of laparotomy, 1 3% and 14%, respectfully, but nonoperative management was more common in th e no-FAST group (p < 0.01). The mean diagnostic cost for the FAST algorithm was $156, compared with $540 with the no-FAST algorithm (p < 0.0001) and t he mean time required for diagnostic work-up was 53 minutes with the FAST a lgorithm, compared with 151 minutes with the no-FAST algorithm (p < 0.0001) . Conclusion: This study has provided prospective evidence that a FAST-based algorithm for blunt abdominal injury was more rapid, less expensive, and as accurate as an algorithm that used computed tomography or diagnostic perit oneal lavage only. Trauma centers are encouraged to incorporate a FAST-base d algorithm into their initial management of blunt trauma victims.