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Focused abdominal sonography for trauma (FAST) in children with blunt abdominal trauma
B D Coley1, K H Mutabagani, L C Martin
1Children's Radiological Institute, Columbus Children's Hospital, OH 43205, USA. bcoley@chi.osu.edu
Insights
Focused abdominal sonography for trauma (FAST) is not a reliable screening tool for children with blunt abdominal trauma. Computed tomography (CT) is superior to FAST in diagnosing injuries in this patient group.
Area of Science:
- Pediatric emergency medicine
- Diagnostic imaging
- Trauma surgery
Background:
- Focused abdominal sonography for trauma (FAST) is established in adults but less so in pediatric blunt abdominal trauma.
- The diagnostic accuracy of FAST in children requires further investigation.
- Computed tomography (CT) is a common imaging modality for pediatric blunt abdominal trauma.
Purpose of the Study:
- To evaluate the diagnostic performance of FAST compared to CT in hemodynamically stable children with blunt abdominal trauma.
- To determine if FAST is an equivalent imaging study to CT for pediatric blunt abdominal trauma.
Main Methods:
- Prospective investigation of 107 hemodynamically stable children with blunt abdominal trauma.
- All children underwent both FAST and CT scans.
- FAST's ability to detect free intraperitoneal fluid was compared to CT findings.
Main Results:
- CT identified injuries in 32 patients; no injuries were missed by CT.
- FAST detected free fluid in 12 patients.
- FAST failed to detect solid organ injuries in 10 patients due to the absence of free fluid, resulting in a sensitivity of 0.55 and a negative predictive value of 0.50.
Conclusions:
- FAST has inadequate sensitivity and negative predictive value for screening hemodynamically stable children with blunt abdominal trauma.
- CT remains the preferred imaging standard for evaluating pediatric blunt abdominal trauma.
- FAST is not recommended as a primary screening tool in this population.
Background:
Focused abdominal sonography for trauma (FAST) has been well reported in adults, but its applicability in children is less well established. We decided to test the hypothesis that FAST and computed tomography (CT) are equivalent imaging studies in the setting of pediatric blunt abdominal trauma.
Methods:
One hundred seven hemodynamically stable children undergoing CT for blunt abdominal trauma were prospectively investigated using FAST. The ability of FAST to predict injury by detecting free intraperitoneal fluid was compared with CT as the imaging standard.
Results:
Thirty-two patients had CT documented injuries. There were no late injuries missed by CT. FAST detected free fluid in 12 patients. Ten patients had solid organ injury but no free fluid and, thus, were not detected by FAST. The sensitivity of FAST relative to CT was only 0.55 and the negative predictive value was only 0.50.
Conclusion:
FAST has insufficient sensitivity and negative predictive value to be used as a screening imaging test in hemodynamically stable children with blunt abdominal trauma.