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Updated: Mar 1, 2026
Focused Assessment with Sonography for Trauma FAST Exam: Image Acquisition
Published on: September 22, 2023
Focused assessment with sonography for trauma in children after blunt abdominal trauma: A multi-institutional
Bennett W Calder1, Adam M Vogel, Jingwen Zhang
1From the Department of Surgery, Division of Pediatric Surgery (B.W.C., J.Z., P.D.M., C.J.S.), Medical University of South Carolina, Charleston, South Carolina; Washington University in St Louis (A.M.V., St. Louis, Missouri; Le Bonheur Children's Hospital (E.Y.H., K.B.S.), University of Tennessee, Memphis, Tennessee, Emory; University School of Medicine (M.T.S.), Atlanta, Georgia; University of Texas Health Science Center (K.J.T., T.G.O.K.), Houston, Texas; Cincinnati Children's Hospital Medical Center (R.E.F.), Cincinnati, Ohio, Arkansas; Children's Hospital, Little Rock (S.D., J.R.), Arkansas, Virginia; Commonwealth University (J.H.H.), Richmond, Virginia; Vanderbilt University Medical Center (M.L.B.), Nashville, Tennessee, Children's Hospital of Alabama (R.T.R.), Birmingham, Alabama; Baylor College of Medicine (B.J.K.M.), Texas Children's Hospital, Houston, Texas, Children's Mercy Hospital (S.D.S.P.), Kansas City, Missouri; Boston Children's Hospital (D.P.M., C.O.), Boston, Massachusetts; and Children's Hospital Los Angeles (J.S.U., J.A.Z.), Los Angeles, California.
Insights
Focused Assessment with Sonography for Trauma (FAST) in children has low sensitivity for intra-abdominal injuries (IAI) and rarely impacts acute intervention decisions after blunt abdominal trauma (BAT). Current FAST use in pediatric trauma needs re-evaluation.
Area of Science:
- Pediatric Trauma Care
- Diagnostic Imaging in Emergency Medicine
- Abdominal Injury Assessment
Background:
- The clinical utility of Focused Assessment with Sonography for Trauma (FAST) in pediatric patients with blunt abdominal trauma (BAT) is not well-established, showing significant practice variations.
- There is a need to clarify the role of FAST in identifying intra-abdominal injuries (IAI) and those requiring acute intervention (IAI-I) in children.
Purpose of the Study:
- To investigate the diagnostic performance and clinical impact of FAST for detecting IAI and IAI-I in children following BAT.
- To compare outcomes and management decisions between children who underwent FAST and those who did not.
Main Methods:
- A prospective, multi-center study enrolled 2,188 children (<16 years) after BAT.
- FAST utilization, subsequent computed tomography (CT) scans, and acute interventions were recorded.
- FAST performance characteristics (sensitivity, specificity, PPV, NPV, accuracy) were evaluated against CT and/or intraoperative findings.
Main Results:
- FAST was used in 37.9% of pediatric BAT patients, with significant center variation (0.84%–94.1%).
- FAST demonstrated low sensitivity for IAI (27.8%) and IAI-I (44.4%), with high false-negative rates (81 injuries missed).
- FAST rarely impacted management, with limited correlation to CT utilization and no improvement in accuracy despite higher FAST frequency.
Conclusions:
- Current application of FAST in pediatric BAT exhibits low sensitivity for detecting intra-abdominal injuries.
- FAST frequently misses injuries requiring acute intervention and has minimal influence on clinical management decisions.
- The study suggests a need to reassess the role and implementation of FAST in pediatric trauma protocols.
Introduction:
The utility of focused assessment with sonography for trauma (FAST) in children is poorly defined with considerable practice variation. Our purpose was to investigate the role of FAST for intra-abdominal injury (IAI) and IAI requiring acute intervention (IAI-I) in children after blunt abdominal trauma (BAT).
Methods:
We prospectively enrolled children younger than 16 years after BAT at 14 Level I pediatric trauma centers over a 1-year period. Patients who underwent FAST were compared with those that did not, using descriptive statistics and univariate analysis; p value less than 0.05 was considered significant. FAST test characteristics were performed using computed tomography (CT) and/or intraoperative findings as the gold standard.
Results:
Two thousand one hundred eighty-eight children (age, 7.8 ± 4.6 years) were included. Eight hundred twenty-nine (37.9%) received a FAST, 340 of whom underwent an abdominal CT. Ninety-seven (29%) of these 340 patients had an IAI and 27 (7.9%) received an acute intervention. CT scan utilization after FAST was 41% versus 46% among those who did not receive FAST. The frequency of FAST among centers ranged from 0.84% to 94.1%. There was low correlation between FAST and CT utilization (r = -0.050, p < 0.001). Centers that performed FAST at a higher frequency did not have improved accuracy. The test performance of FAST for IAI was sensitivity, 27.8%; specificity, 91.4%; positive predictive value, 56.2%; negative predictive value, 76.0%; and accuracy, 73.2%. There were 81 injuries among the 70 false-negative FAST. The test performance of FAST for IAI-I was sensitivity, 44.4%; specificity, 88.5%; positive predictive value, 25.0%; negative predictive value, 94.9%; and accuracy, 85.0%. Fifteen children with a negative FAST received acute interventions. Among the 27 patients with true positive FAST examinations, 12 received intervention. All had an abnormal abdominal physical examination. No patient underwent intervention before CT scan.
Conclusion:
As currently used, FAST has a low sensitivity for IAI, misses IAI-I and rarely impacts management in pediatric BAT.
Level Of Evidence:
Prognostic and epidemiologic study, level II; diagnostic tests or criteria study, level II; therapeutic/care management study, level III.
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