Written by Chris Thom
Spoon Feed
In this single-center study, the FAST exam took about 3 minutes to complete, and 80% of the exams had at least one non-diagnostic anatomical window.
Quality and experience matter in ensuring high-quality FAST
This was a cross-sectional study at a single trauma center involving an analysis of video recordings of FAST examinations along with concomitant FAST imaging data. Adult blunt trauma patients were included. The FAST exams were performed by general surgery residents. Time was defined as first to last probe-to-skin contact. Images were reviewed and quality determined by two radiologists using the previously validated QUICk scale.
FAST clips were successfully saved in 51 out of the 93 enrollments (61%). Of these, 80% had at least one non-diagnostic window. Diagnostic level images were achieved in 82% of hepatorenal images, but only 47% of splenorenal images. On a 1 to 5 Likert scale quality rating, average scores were between 3 and 3.65, dependent on the anatomical window. The overall sensitivity of the FAST for free fluid in the cohort was 54% and specificity was 92%.
How does this change my practice?
We often start with the FAST exam for POCUS education. It involves identifying relatively large and easy-to-recognize organs and quick mastery. However, the current study is a reminder that inexperienced operators tend to have much poorer imaging quality and interpretation accuracy than what is commonly reported in the literature. Prior work has established that competency can occur with as few as 10-12 FAST exams when feedback is provided during training. An effective FAST education program can be brief but must still be thoughtful and targeted. Unfortunately, going to ATLS and then immediately grabbing the probe is not a recipe for success.
POCUS pro-tips and clips
Each window has its own trick. For today, we’ll focus on the splenorenal view, where the image quality was the poorest. One tends to get a much clearer view of the splenorenal space via a more posterior position of the probe. Slide your hand posteriorly until you are at, or almost at, the stretcher. Then aim the probe slightly anterior and you will often be right at the splenorenal space. Keep in mind, free fluid in the left upper quadrant often accumulates above the spleen in the subdiaphragmatic space, so be sure to image there as well (see clip).
Source
Is the FAST Exam Actually Fast? Utilizing Trauma Video Review to Assess FAST User Performance. J Surg Educ. 2025 Jun;82(6):103517. doi: 10.1016/j.jsurg.2025.103517. Epub 2025 May 1. PMID: 40315788
