Shackford S R, Rogers F B, Osler T M, Trabulsy M E, Clauss D W, Vane D W
University of Vermont, Department of Surgery, Burlington 05401, USA.
J Trauma. 1999 Apr;46(4):553-62; discussion 562-4. doi: 10.1097/00005373-199904000-00003.
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.
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."
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 (chi2; p < 0.05).
Previous recommendations for the number of proctored examinations for individual nonradiologist clinician sonographers to develop competence are excessive.
创伤重点腹部超声检查（FAST）已被外科医生和急诊科医生用于创伤后可靠筛查腹腔积血。尽管有关于“适当培训”的建议，即需要进行50至400次有监督的检查，但并无支持数据。
我们前瞻性地检查了急诊科医生在检测腹腔积血方面的初始FAST经验，以诊断性腹腔灌洗、计算机断层扫描和临床发现作为诊断“金标准”。
12名急诊科医生对241例患者进行了FAST检查（平均每位医生20例；范围为2至43例）；51例患者（21.2%）有腹腔积血，17例患者（7.1%）需要剖腹手术。急诊科医生的FAST初始经验产生了35例假阳性、180例假阴性、16例假阴性和3例假阳性；敏感性为68%；特异性为98%。初始错误率为17%，在进行10次检查后降至5%（卡方检验；p<0.05）。
先前关于个体非放射科临床超声检查医生培养能力所需监督检查次数的建议过多。
