Document Detail

Defining the learning curve for the Focused Abdominal Sonogram for Trauma (FAST) examination: implications for credentialing.
MedLine Citation:
PMID:  11308006     Owner:  NLM     Status:  MEDLINE    
Focused Abdominal Sonogram for Trauma (FAST) examination is being used increasingly for the torso evaluation of injured patients. In a controlled setting using peritoneal dialysis patients as models for injured patients with free fluid we hypothesized that more experienced providers would perform FAST with greater accuracy. Twelve fellow or attending level trauma surgeons, two radiologists, and one ultrasound technician were studied for their ability to detect intraperitoneal fluid (0-1600 cm3) in nine peritoneal dialysis patients with two different volumes of dialysate/patient. FAST experience with injured patients was defined as minimal (<30 patients examinations), moderate (30-100), or extensive (>100). All surgeons had participated in a didactic/practical course before the study. Test results were reported as "+" or "-" by the participant; "+" results were further quantified by volume. The sensitivity of those in the minimal-, moderate-, and extensive-experience to detect <1 L was 45, 87, and 100 per cent, respectively; the accuracy in detecting dialysate volume within 250 cm3 was 38, 63, and 90 per cent, respectively. In this controlled setting the accuracy of FAST particularly in diagnosing smaller volumes, as well as the ability to quantify volume, improves with experience. The learning curve for FAST starts to flatten out at 30 to 100 examinations. Training and credentialing policies should consider these findings to optimize patient care.
V H Gracias; H L Frankel; R Gupta; J Malcynski; R Gandhi; L Collazzo; H Nisenbaum; C W Schwab
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Publication Detail:
Type:  Journal Article; Validation Studies    
Journal Detail:
Title:  The American surgeon     Volume:  67     ISSN:  0003-1348     ISO Abbreviation:  Am Surg     Publication Date:  2001 Apr 
Date Detail:
Created Date:  2001-04-18     Completed Date:  2001-05-03     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  0370522     Medline TA:  Am Surg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  364-8     Citation Subset:  IM    
Division of Traumatology and Surgical Critical Care, The University of Pennsylvania Medical Center, Philadelphia, USA.
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MeSH Terms
Abdominal Injuries / complications*
Clinical Competence / standards*
Credentialing / organization & administration*
Double-Blind Method
Education, Medical, Continuing / organization & administration*
Hemoperitoneum / etiology*,  ultrasonography*
Inservice Training / organization & administration*
Medical Staff, Hospital / education*
Needs Assessment
Peritoneal Dialysis
Prospective Studies
Radiology / education*
Sensitivity and Specificity
Time Factors
Traumatology / education*
Ultrasonography / methods*,  standards*

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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