Rozycki G S, Ballard R B, Feliciano D V, Schmidt J A, Pennington S D
Department of Surgery, Grady Memorial Hospital and Emory University School of Medicine, Atlanta, Georgia 30303, USA.
Ann Surg. 1998 Oct;228(4):557-67. doi: 10.1097/00000658-199810000-00012.
To determine the accuracy of the Focused Assessment for the Sonographic examination of the Trauma patient (FAST) when performed by trauma team members during a 3-year period, and to determine the clinical conditions in which the FAST is most accurate in the assessment of injured patients.
The FAST is a rapid test that sequentially surveys the pericardial region for hemopericardium and then the right and left upper quadrants and pelvis for hemoperitoneum in patients with potential truncal injuries. The clinical conditions in which the FAST is most accurate in the assessment of injured patients have yet to be determined.
FAST examinations were performed on patients with precordial or transthoracic wounds or blunt abdominal trauma. Patients with a positive ultrasound (US) examination for hemopericardium underwent immediate surgery, whereas those with a positive US for hemoperitoneum underwent a computed tomography scan (if they were hemodynamically stable) or immediate celiotomy (if they were hemodynamically unstable- blood pressure < or = 90 mmHg).
FAST examinations were performed in 1540 patients (1227 with blunt injuries, 313 with penetrating injuries). There were 1440 true-negative results, 80 true-positive results, 16 false-negative results, and 4 false-positive results; the sensitivity was 83.3%, the specificity 99.7%. US was most sensitive and specific for the evaluation of patients with precordial or transthoracic wounds (sensitivity 100%, specificity 99.3%) and hypotensive patients with blunt abdominal trauma (sensitivity 100%, specificity 100%).
US should be the initial diagnostic modality for the evaluation of patients with precordial wounds and blunt truncal injuries because it is rapid and accurate. Because of the high sensitivity and specificity of US in the evaluation of patients with precordial wounds and hypotensive patients with blunt torso trauma, immediate surgical intervention is justified when those patients have a positive US examination.
确定创伤团队成员在3年期间对创伤患者进行超声重点评估（FAST）检查的准确性，并确定FAST在评估受伤患者时最准确的临床情况。
FAST是一种快速检查，用于对可能存在躯干损伤的患者依次检查心包区域有无心包积血，然后检查右上腹、左上腹和骨盆有无腹腔积血。FAST在评估受伤患者时最准确的临床情况尚未确定。
对有心前区或经胸伤口或钝性腹部创伤的患者进行FAST检查。超声检查心包积血阳性的患者立即接受手术，而腹腔积血超声检查阳性的患者（如果血流动力学稳定）接受计算机断层扫描，（如果血流动力学不稳定——血压≤90 mmHg）则立即进行剖腹手术。
对1540例患者进行了FAST检查（1227例钝性损伤，313例穿透性损伤）。有1440例假阴性结果，80例假阳性结果，16例假阴性结果和4例假阳性结果；敏感性为83.3%，特异性为99.7%。超声对评估有心前区或经胸伤口的患者（敏感性100%，特异性99.3%）和低血压钝性腹部创伤患者（敏感性100%，特异性100%）最为敏感和特异。
超声应作为评估心前区伤口和钝性躯干损伤患者的初始诊断方法，因为它快速且准确。由于超声在评估心前区伤口患者和低血压钝性躯干创伤患者时具有高敏感性和特异性，当这些患者超声检查阳性时，立即进行手术干预是合理的。
