The application of focused assessment with sonography for trauma in resource-limited settings: a scoping review.

Background: Trauma represents a leading cause of mortality and disability in resource-limited settings. However, access to advanced imaging modalities is severely constrained, limiting timely and accurate diagnosis as well as clinical decision-making. Focused assessment with sonography for trauma (FAST) offers a portable, non-ionizing, and cost-effective bedside imaging solution with significant potential for clinical application. It enables rapid identification of life-threatening hemoperitoneum or hemothorax, thereby guiding immediate surgical intervention or preventing unnecessary patient transfers. As such, FAST contributes to improved triage, reduced decision-making time, and enhanced efficiency in trauma care delivery within these contexts. Nevertheless, there remains a lack of comprehensive synthesis regarding its implementation models, effectiveness, and associated challenges in low-resource environments. Methods: Adhering to the PRISMA 2020 guidelines, a systematic literature search was conducted across six databases-PubMed, Embase, Cochrane Library, Scopus, Web of Science, and SinoMed-up to October 11, 2025. Study screening, quality assessment, and data extraction were performed independently, resulting in the inclusion of 29 eligible studies. Results: The synthesis of 29 included studies demonstrates that FAST is a highly effective tool in resource-limited settings. It exhibits high specificity (94%-100%) in detecting free intraperitoneal fluid, supporting reliable clinical decision-making. FAST has been successfully integrated into diverse healthcare contexts, including pre-hospital emergency response and primary care clinics. A critical enabler of its implementation is task-shifting, with nurses, general practitioners, and other non-specialist healthcare providers serving as primary operators. Nonetheless, persistent challenges include limited equipment availability and difficulties in maintaining operator competency, underscoring the need for innovative solutions such as remote tele-guidance, cascade training programs, and the development of local training capacity. Conclusion: As a rapid, portable, and cost-efficient diagnostic modality, FAST plays a vital role in strengthening trauma care systems in resource-limited settings. Despite existing limitations, its sustainable scale-up depends on the integration of technological access, robust training frameworks, and supportive health policies. Such a multifaceted approach is essential to improving survival rates and long-term outcomes for trauma patients in these regions and advancing global trauma care equity. Systematic review registration: https://doi.org/10.17605/OSF.IO/2T7BK.