The role of focused abdominal sonography for trauma (FAST) in pediatric trauma evaluation

https://doi.org/10.1016/j.jpedsurg.2013.03.038Get rights and content

Abstract

Purpose

With increasing concerns about radiation exposure, we questioned whether a structured program of FAST might decrease CT use.

Methods

All pediatric trauma surgeons in our level 1 pediatric trauma center underwent formal FAST training. Children with potential abdominal trauma and no prior imaging were prospectively evaluated from 10/2/09 to 7/31/11. After physical exam and FAST, the surgeon declared whether the CT could be eliminated.

Results

Of 536 children who arrived without imaging, 183 had potential abdominal trauma. FAST was performed in 128 cases and recorded completely in 88. In 48% (42/88) the surgeon would have elected to cancel the CT based on the FAST and physical exam. One of the 42 cases had a positive FAST and required emergent laparotomy; the others were negative. The sensitivity of FAST for injuries requiring operation or blood transfusion was 87.5%. The sensitivity, specificity, PPV, and NPV in detecting pathologic free fluid were 50%, 85%, 53.8%, and 87.9%.

Conclusions

True positive FAST exams are uncommon and would rarely direct management. While the negative FAST would have potentially reduced CT use due to practitioner reassurance, this reassurance may be unwarranted given the test's sensitivity.

Section snippets

FAST training

Six surgeons were trained and evaluated over an average of 16 months prior to initiation of the study. Training included technical instruction on use of the US machine, and viewing of an instructional video on FAST. A didactic session was held to teach the principles and physics of US and FAST, as well as provide hands-on training in the approach to the FAST exam. Proctored exams occurred in the clinic setting, as well as during trauma resuscitations. Proctoring and further training were

Results

During the study period, 676 children required activation of the trauma team for evaluation of traumatic injury. Of these, 140 presented with prior abdominal imaging at an outside facility, and were excluded for analysis. Of the remaining 536 cases, 183 had potential abdominal trauma, as indicated by planned use of abdominal CT during initial evaluation, and not having open or penetrating abdominal wound. Out of these 183 cases considered eligible for enrollment into the study, ultrasound was

Discussion

The interest in emergency US in pediatric EDs has increased dramatically in recent history. A survey of children's hospitals and pediatric emergency medicine training programs revealed that 96% of responders reported having a dedicated US machine in the ED but only 27% reported having a program for the clinical use of US. It is concerning that of those who use US only 52% of the institutions had established credentialing criteria to grant US privileges [13]. The American College of Surgeons

References (18)

There are more references available in the full text version of this article.

Cited by (75)

  • Strategies in liver Trauma

    2020, Seminars in Pediatric Surgery
  • The ABC-D score improves the sensitivity in predicting need for massive transfusion in pediatric trauma patients

    2020, Journal of Pediatric Surgery
    Citation Excerpt :

    The ABC score, which is used in adult MTP activations, is limited in pediatric trauma patients due to low rates of penetrating injuries (10% in our cohort) and positive FAST exams (12% in our cohort). While the FAST exam has high sensitivity and specificity in the adult trauma population, FAST lacks sensitivity in the pediatric trauma population, due to wide variability in user experience and expertise [20]. To date, there remains a paucity of literature on the appropriate triggers of MT in pediatric patients and protocols vary by the institution [16].

View all citing articles on Scopus
View full text