Secondary ultrasound examination increases the sensitivity of the FAST exam in blunt trauma

J Trauma. 2004 Nov;57(5):934-8. doi: 10.1097/01.ta.0000149494.40478.e4.


Introduction: Approximately one third of stable patients with significant intra-abdominal injury do not have significant intraperitoneal blood evident on admission. We hypothesized that a delayed, repeat ultrasound study (Secondary Ultrasound--SUS) will reveal additional intra-abdominal injuries and hemoperitoneum.

Methods: We performed a prospective observational study of trauma patients at our Level I trauma center from April 2003 to December 2003. Patients underwent an initial ultrasound (US), followed by a SUS examination within 24 hours of admission. Patients not eligible for a SUS because of early discharge, operative intervention or death were excluded. All US and SUS exams were performed and evaluated by surgical/emergency medicine house staff or surgical attendings.

Results: Five hundred forty-seven patients had both an initial US and a SUS examination. The sensitivity of the initial US in this patient population was 31.1% and increased to 72.1% on SUS (p < 0.001) for intra-abdominal injury or intra-abdominal fluid. The specificity for the initial US was 99.8% and 99.8% for SUS. The negative predictive value was 92.0% for the initial US and increased to 96.6% for SUS (p = 0.002). The accuracy of the initial ultrasound was 92.1% and increased to 96.7% on the SUS (p < 0.002). No patient with a negative SUS after 4 hours developed clinically significant hemoperitoneum.

Conclusion: A secondary ultrasound of the abdomen significantly increases the sensitivity of ultrasound to detect intra-abdominal injury.

Publication types

  • Evaluation Study

MeSH terms

  • Abdomen / diagnostic imaging*
  • Abdomen / surgery
  • Abdominal Injuries / diagnostic imaging*
  • Abdominal Injuries / physiopathology
  • Abdominal Injuries / surgery
  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Child
  • Child, Preschool
  • Diagnosis, Differential
  • Female
  • Florida
  • Hemoperitoneum / diagnostic imaging*
  • Hemoperitoneum / etiology
  • Hemoperitoneum / surgery
  • Hospitals, University
  • Humans
  • Infant
  • Laparotomy
  • Male
  • Middle Aged
  • Predictive Value of Tests
  • Prospective Studies
  • Sensitivity and Specificity
  • Time Factors
  • Trauma Centers
  • Ultrasonography
  • Wounds, Nonpenetrating / diagnostic imaging*
  • Wounds, Nonpenetrating / physiopathology
  • Wounds, Nonpenetrating / surgery