Focused Assessment with Sonography in Trauma for Assessment of Injury in Military Settings: A Meta-analysis

Abstract

Background: Non-invasive, rapid, and precise assessment of injuryin the military settings is extremely important, yet difficult. Focusedassessment with sonography in trauma (FAST) is being increasinglyemployed for assessing the location and severity of injury and guidingfurther treatment strategy. However, the evidence regarding the utilityof FAST in the military settings is scattered.Aims: To evaluate the diagnostic performance of FAST in theassessment of injury in the military settings.Study Design: Meta-analysis.Methods: We identified all relevant papers via the PubMed,EMBASE, and Cochrane Library databases. We evaluated the qualityof included studies by the Quality Assessment of Diagnostic AccuracyStudies-2 tool. We pooled the area under the curve (AUC), sensitivity,specificity, positive and negative likelihood ratios, and diagnosticodds ratio as the effect sizes, followed by evaluating the heterogeneityamong the studies by p value and I2.Results: Among the 39 papers, a total of six papers were included. Thesample size ranged from 15 to 396. The AUC of FAST for assessingthe injury was 0.85. The pooled sensitivity, specificity, positive andnegative likelihood ratios, and diagnostic odds ratio were 0.66, 0.98,33.1, 0.34, and 97, respectively. The heterogeneity among the studieswas statistically significant (p=0.006, I2=78%).Conclusion: FAST is potentially valuable for assessing injury in themilitary settings. Due to its high specificity, FAST may be appropriateto rule in significant injury. However, because of its poor sensitivity,the ability of FAST to rule out injury cannot be relied upon.