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Focused Assessment with Sonography for Trauma (FAST) Exam: Image Acquisition
07:18

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

Published on: September 22, 2023

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

Eric R Scaife1, Michael D Rollins, Douglas C Barnhart

  • 1Division of Pediatric Surgery, University of Utah, Salt Lake City, UT, USA. eric.scaife@hsc.utah.edu

Journal of Pediatric Surgery
|July 13, 2013
PubMed

Insights

Focused Assessment with Sonography for Trauma (FAST) exams rarely change management in pediatric abdominal trauma. Negative FAST results may offer unwarranted reassurance, potentially increasing CT use rather than decreasing it.

Area of Science:

  • Pediatric Trauma Surgery
  • Diagnostic Imaging
  • Emergency Medicine

Background:

  • Growing concerns regarding radiation exposure in pediatric patients.
  • Need for strategies to reduce computed tomography (CT) utilization in trauma care.

Purpose of the Study:

  • To evaluate if a structured Focused Assessment with Sonography for Trauma (FAST) program can decrease CT use in children with potential abdominal trauma.
  • To assess the impact of surgeon-led FAST on clinical decision-making regarding CT scans.

Main Methods:

  • Formal FAST training for all pediatric trauma surgeons at a Level 1 trauma center.
  • Prospective evaluation of children with potential abdominal trauma and no prior imaging.
  • Surgeons determined if CT could be eliminated post-physical exam and FAST.

Main Results:

  • Of 183 children with potential abdominal trauma, FAST was performed in 128. Surgeons would have canceled CT in 48% (42/88) based on FAST and physical exam.
  • One positive FAST case required emergent laparotomy; others were negative. FAST sensitivity for injuries needing operation/transfusion was 87.5%.
  • Sensitivity and specificity for detecting pathologic free fluid were 50% and 85%, respectively.

Conclusions:

  • True positive FAST exams are infrequent and seldom alter management decisions.
  • Negative FAST results may provide false reassurance, potentially hindering CT use reduction and possibly leading to unwarranted confidence.
  • The overall sensitivity of FAST in this cohort suggests caution when using it to exclusively rule out significant injuries.
Abstract

Keywords:
Focused abdominal sonography for trauma (FAST)Pediatric trauma

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