TRAUMA QUALITY IMPROVEMENT
Is the FAST Exam Actually Fast? Utilizing Trauma Video Review to Assess FAST User Performance
Published on
Jun 15, 2025
Journal of Surgical Education
Bahaa Succar MD, Madhuri Nagaraj MD, Kaustubh Gopal MEd, Macy Afsari BS, David T. Fetzer MD, Naveen Rajamohan MD, Hebert J. Zeh III MD, Ryan P. Dumas MD, FACS
Overview
This study evaluates the real-world performance of surgical trainees conducting the Focused Assessment with Sonography for Trauma (FAST) using trauma video review (TVR). While FAST is valued for its speed in emergency settings, its accuracy and image quality when performed by trainees are less understood. The researchers reviewed video-recorded blunt trauma activations, analyzing both the time taken and the quality of the imaging. Two radiologists assessed the technical and diagnostic aspects of saved FAST clips, and findings were compared against CT scans and surgical outcomes to determine diagnostic accuracy.
Results
A total of 93 FAST exams were reviewed, with a median completion time of 2.9 minutes, even when accounting for clinical interruptions. Despite this efficiency, only 20% of saved clips demonstrated diagnostic-quality imaging across all anatomic windows. Most cases (80%) had at least one nondiagnostic window, and overall image quality scores indicated mild to moderate room for improvement. Trainees showed competence in performing the exam (average total checklist score: 17.9/24), but diagnostic sensitivity was low at 54%, though specificity remained high at 92%. These findings underscore the need for targeted training in FAST image acquisition and interpretation to improve diagnostic accuracy.
Peer-reviewed Research
