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Preliminary experience with focused abdominal sonography for trauma (FAST) in children: is it useful?
K H Mutabagani1, B D Coley, N Zumberge
1Department of Pediatric Surgery, The Ohio State University College of Medicine and Public Health and Children's Hospital, Columbus, USA.
Insights
Focused abdominal sonography for trauma (FAST) is not a useful screening tool for diagnosing intraabdominal injuries in children. This study found FAST had low sensitivity, missing several injuries that computed tomography (CT) detected.
Area of Science:
- Pediatric Radiology
- Emergency Medicine
- Trauma Surgery
Background:
- Computed tomography (CT) is the preferred imaging modality for pediatric intraabdominal injury.
- Many children undergoing CT for suspected injury have normal scans.
- Focused abdominal sonography for trauma (FAST) is effective in adults but understudied in children.
Purpose of the Study:
- To assess the utility of FAST as a screening tool for intraabdominal injuries in pediatric patients.
- To determine if FAST can reduce the number of normal CT scans performed in children.
- To evaluate FAST performance in a pediatric trauma population.
Main Methods:
- Prospective screening of hemodynamically stable children with suspected intraabdominal injury using FAST.
- FAST performed by pediatric radiologists at four sites, averaging 2 minutes.
- All patients subsequently underwent CT scan for definitive diagnosis and management decisions.
Main Results:
- FAST identified 4 of 13 injuries (31% sensitivity), with 9 false-negative scans.
- CT revealed 13 injuries, including solid organ damage not detected by FAST.
- FAST demonstrated 100% specificity but low sensitivity (0.3) for intraabdominal injury detection.
Conclusions:
- FAST alone is insufficient as a screening test for pediatric intraabdominal injury.
- The low sensitivity of FAST indicates it misses significant injuries in children.
- Further research is needed to explore alternative or adjunctive screening methods for pediatric trauma.
Background/Purpose:
Most pediatric surgeons and pediatric radiologists consider computed tomography (CT) the best radiological test for the evaluation of children with suspected intraabdominal injury. The majority of injured children evaluated with CT will be found to have a normal scan. Focused abdominal sonography for trauma (FAST) has been shown to be a useful screening test in the evaluation of adult patients with suspected intraabdominal injury. Limited data exist regarding the use of FAST in children. Our aim was to evaluate the usefulness of FAST as a screening test in the evaluation of children with suspected intraabdominal injury in an attempt to minimize the number of normal CT scans performed.
Methods:
Hemodynamically stable children evaluated for suspected intraabdominal injury were prospectively screened with FAST. FAST, real-time sonography at four sites, was performed by staff pediatric radiologists. The average duration of the examination was 2 minutes. Positive and negative FAST scan findings were defined prospectively. The result of each FAST was recorded (positive or negative) and then all patients underwent CT as a control. All management decisions were based on CT results.
Results:
Forty-six patients were included in the study. FAST identified four children with positive findings (free intraperitoneal fluid), whereas CT showed 13 children with injuries (nine with associated free intraperitoneal fluid and four with only solid organ injury and no associated intraperitoneal fluid). There were nine false-negative and no false-positive FAST scans. The sensitivity of FAST was 0.3 and the specificity was 1.0. Injuries missed by FAST included liver laceration, adrenal hematoma, renal laceration, small bowel injury and splenic laceration.
Conclusion:
Preliminary results suggest that FAST alone is not a useful screening test in the evaluation of children with suspected intraabdominal injury.
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