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FAST Scan in the Diagnosis of Haemoperitoneum of Haemodynamically Stable Patients with Suspected Blunt Abdominal Trauma

Three Part Question

In [haemodynamically stable patients with blunt abdominal trauma] how useful is [Focussed Assessment with Ultrasound for Trauma] at [diagnosing haemoperitoneum]?

Clinical Scenario

A 25 year old haemodynamically stable patient presents to the emergency department following a high speed RTA with suspected intraabdominal injury. You wonder whether an FAST scan would be helpful for diagnosis.

Search Strategy

Medline 1966-03/07 using the Medline interface.
[Focussed AND ultrasound AND abdominal trauma AND sensitivity]

Search Outcome

65 papers were found of which 62 were irrelevant or of insufficient quality for inclusion. The remaining 3 papers are shown below.

Relevant Paper(s)

Author, date and country Patient group Study type (level of evidence) Outcomes Key results Study Weaknesses
Miller, MT et al.
372 haemodynamically stable patients with suspected BAI (Blunt Abdominal Injury) (age 2-93) at a level I trauma centre)Diagnositic cohort, prospectiveHemoperitoneumSensitivity: 42%

Specificity: 98%

Positive Predicitive Value: 67%

Negative Predicitive Value: 93%

Accuracy: 92%

Discordance US/CT: significant

Power: 92%
Objectives not clearly defined
Rozycki, MD et al.
1197 haemodynamically stable patients with suspected BAI (Blunt Abdominal Injury) (age 15-84) at an urban level I trauma centre) with a minimum of an 24h observation periodDiagnositic cohort, prospectiveHaemoperitoneumSensitivity: 75%

Specificity: 99.8%
Not all patients underwent CT scan.
Lee, BC et al.
3907 haemodynamically stable patients with suspected BAI (Blunt Abdominal Injury) at a regional level I trauma centre)Diagnositic cohort, retrospectiveHemoperitoneumSensitivity: 85%


Positive Predicitve Value: 59%

Negative Predicitve Value: 99%

Accuracy: 96%
Retrospective, selection of patients based on completeness of clinical/radiological/surgical information


These studies show that Focussed Assessment with Ultrasound of Trauma has a high specificity for the diagnosis of haemoperitoneum. Data on its sensitivity in this clinical scenario are inconsistent. Further research investigating the sensitivity in a prospective powerful study with application of an independent gold standard test for all subjects is warranted.

Clinical Bottom Line

A positive FAST scan is highly specific and can be used to rule in haemoperitoneum in haemodynamically stable patients with suspected blunt abdominal injury.


  1. Miller, MT et al. Not so fast J Trauma 2003;54(1):52-9.
  2. Rozycki GS et al. Surgeon-Performed Ultrasound for the Assessment of Truncal Injuries: Lessons learned from 1540 Patients Annals of Surgery 1998;228(4):557-567
  3. Lee BC et al. The Utility of Sonography for the Triage of Blunt Abdominal Trauma Patients to Exploratory Laparotomy American Journal of Roentgenology 2007; 188: 415-421