Focused Assessment with Sonography for Trauma Examinations Acquisition and Diagnostic Accuracy of Interpretation by Paramedics
Keywords:
diagnostic accuracy, paramedic, FAST, ultrasonographyAbstract
Background and Objective: Prehospital Focused Assessment with Sonography in Trauma (FAST) training has resulted in improved trauma patient outcomes in multiple countries. Previous studies demonstrated good accuracy. However, data regarding the diagnostic performance among paramedics in developing countries is sparse. This study’s purpose was to examine the diagnostic accuracy of paramedic FAST exam interpretation and the success rate of image acquisition.
Materials and methods: This was a prospective observational study of trauma patients who received a FAST examination performed in the emergency department. Paramedics who worked at a tertiary emergency department in Khon Kaen hospital were included in this study. A 2-hour didactic lecture and 2-hour hands-on practice, followed by internet-based didactic session for review were provided by ultrasound-trained emergency physician. The diagnostic indices for FAST interpretation were calculated. Paramedics were also tested on image acquisition skills on a standardized patient using a standardized assessment tool.
Results: In total, 10 paramedics voluntarily participated and underwent FAST training. FAST exams from 200 patients performed in the emergency department were evaluated by paramedics. The paramedics were mostly ultrasound-naïve. The sensitivity, specificity, positive predictive value, and negative predictive value for image interpretation by paramedics compared to FAST results by ultrasound-trained emergency physician were 91.9% (95% CI, 78.1 - 98.3), 89.6% (95% CI, 83.8 - 93.8), 66.7% (95% CI, 55.8 - 76.0), and 98.0% (95% CI, 94.3 - 99.3), respectively. The overall accuracy was 90.0%. All of the paramedics were able to successfully complete 100% of the views of the FAST and achieved a practical standard considered by the ultrasound-trained emergency physician.
Conclusions: This study determined that paramedics were able to interpret FAST exams with a high degree of accuracy and perform FAST in a simulated environment following a four-hour training course.
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