Focused Assessment with Sonography for Trauma (FAST) has become a cornerstone of early trauma evaluation due to its rapid execution, bedside availability, and noninvasive nature. Its primary role is the detection of free fluid, serving as an indirect marker of significant intra-abdominal injury. However, the accuracy of FAST for diagnosing specific visceral injuries remains variable, particularly when distinguishing solid organ from hollow viscus lesions. This narrative review analyzes current evidence regarding the role of FAST in the early diagnosis of visceral injuries in trauma patients. A structured literature search was conducted in PubMed, SciELO, and Scopus databases. The diagnostic performance of FAST, its clinical applicability in hemodynamically unstable and stable patients, and its limitations in comparison with computed tomography are discussed. The findings indicate that FAST is highly specific for detecting hemoperitoneum and is particularly valuable in unstable patients, where it facilitates rapid surgical decision-making. Nevertheless, its limited sensitivity for isolated visceral and hollow viscus injuries underscores the need for integration with clinical assessment and advanced imaging.
References
Healey MA, Simons RK, Winchell RJ, Gosink BB, Casola G, Steele JT, et al. A prospective evaluation of abdominal ultrasound in blunt trauma. J Trauma. 1996;40(6):875-81.
Kirkpatrick AW, Sirois M, Laupland KB, Goldstein L, Brown DR, Simons RK, Dulchavsky S, Boulanger BR. Prospective evaluation of hand-held focused abdominal sonography for trauma (FAST) in blunt abdominal trauma. Can J Surg. 2005 Dec;48(6):453-60. PMID: 16417051; PMCID: PMC3211725.
Matsushima K, Khor D, Berne TV, Asensio JA, Demetriades D. Beyond FAST: limitations in abdominal trauma. World J Surg. 2011;35(4):927-31. doi: 10.1007/s00268-011-0988-2.
Richards JR, McGahan JP. Focused Assessment with Sonography in Trauma (FAST) in 2017: What Radiologists Can Learn. Radiology. 2017 Apr;283(1):30-48. doi: 10.1148/radiol.2017160107. PMID: 28318439.
Tsui CL, Fung HT, Chung KL, Kam CW. Focused abdominal sonography for trauma in the emergency department for blunt abdominal trauma. Int J Emerg Med. 2008 Sep;1(3):183-7. doi: 10.1007/s12245-008-0050-2. Epub 2008 Sep 26. PMID: 19384513; PMCID: PMC2657279.
Rowell SE, Barbosa RR, Holcomb JB, Fox EE, Barton CA, Schreiber MA. The focused assessment with sonography in trauma (FAST) in hypotensive injured patients frequently fails to identify the need for laparotomy: a multi-institutional pragmatic study. Trauma Surg Acute Care Open. 2019 Jan 24;4(1):e000207. doi: 10.1136/tsaco-2018-000207. PMID: 30793035; PMCID: PMC6350755.
Waheed KB, Baig AA, Raza A, Ul Hassan MZ, Khattab MA, Raza U. Diagnostic accuracy of Focused Assessment with So-nography for Trauma for blunt abdominal trauma in the Eastern Region of Saudi Arabia. Saudi Med J. 2018 Jun;39(6):598-602. doi: 10.15537/smj.2018.6.22031. PMID: 29915855; PMCID: PMC6058749.
Moylan M, Newgard CD, Ma OJ, Sabbaj A, Rogers T, Douglass R. Association between a positive ED FAST examination and therapeutic laparotomy in normotensive blunt trauma patients. J Emerg Med. 2007 Oct;33(3):265-71. doi: 10.1016/j.jemermed.2007.02.030. Epub 2007 Jul 5. PMID: 17976554.