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Focused Assessment with Sonography for Trauma (FAST) Exam: Image Acquisition

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Published on: September 22, 2023

Blunt abdominal trauma in children.

Deborah Schonfeld¹, Lois K Lee

¹Division of Emergency Medicine, Children's Hospital, Boston, Harvard Medical School, Boston, Massachusetts, USA.

Current Opinion in Pediatrics

|March 28, 2012

Summary

Diagnosing intra-abdominal injuries (IAI) in pediatric blunt abdominal trauma requires careful evaluation. While the FAST exam aids in identifying at-risk children, normal physical exams and CT scans may preclude the need for hospitalization.

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Area of Science:

Pediatric Surgery
Emergency Medicine
Trauma Care

Background:

Blunt abdominal trauma is a significant concern in pediatric patients.
Accurate diagnosis of intra-abdominal injuries (IAI) is crucial for appropriate management.
Current diagnostic strategies involve physical examination, laboratory tests, and imaging modalities.

Purpose of the Study:

To review the evidence on physical exam findings, laboratory values, and imaging in diagnosing pediatric blunt abdominal trauma.
To examine literature on pediatric hollow viscus injuries.
To discuss emergency department disposition after IAI diagnosis.

Main Methods:

Comprehensive literature review of pediatric blunt abdominal trauma.
Analysis of diagnostic tools including physical exam, laboratory screening, and imaging (FAST, CT).
Evaluation of management strategies and disposition criteria for suspected IAI.

Main Results:

The utility of the seat belt sign and screening labs for IAI is debated; hepatic enzymes are recommended for nonaccidental trauma.
Focused Assessment with Sonography for Trauma (FAST) has limited sensitivity for hemoperitoneum and IAI in pediatric trauma.
Hospital admission with serial exams is safe for patients with suspected IAI if emergent laparotomy is not indicated.

Conclusions:

The FAST exam, combined with physical exam and labs, can help identify children at risk for IAI but is not a sole screening tool.
Hemodynamically stable pediatric trauma patients with normal physical exams and abdominal CT scans may not require routine hospitalization.