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Effect of Abdominal Ultrasound on Clinical Care, Outcomes, and Resource Use Among Children With Blunt Torso Trauma: A
James F Holmes1, Kenneth M Kelley1, Sandra L Wootton-Gorges2
1Department of Emergency Medicine, University of California, Davis School of Medicine, Sacramento.
Insights
The focused assessment with sonography for trauma (FAST) examination did not improve clinical care for hemodynamically stable children with blunt torso trauma. Routine use of FAST in this pediatric trauma population is not supported by these findings.
Area of Science:
- Emergency Medicine
- Pediatric Trauma
- Diagnostic Imaging
Background:
- The utility of the focused assessment with sonography for trauma (FAST) examination in pediatric patients with blunt torso trauma is not well-established.
- Current clinical guidelines do not uniformly recommend FAST for this population.
Purpose of the Study:
- To determine if the FAST examination improves clinical care during the initial evaluation of injured children.
- To assess the impact of FAST on resource utilization, diagnostic accuracy, and patient outcomes in pediatric trauma.
Main Methods:
- A randomized clinical trial involving 975 hemodynamically stable children and adolescents with blunt torso trauma.
- Patients were randomized to either standard trauma evaluation with FAST or standard trauma evaluation alone.
- Coprimary outcomes included abdominal CT scan rates, missed intra-abdominal injuries, ED length of stay, and hospital charges.
Main Results:
- No significant difference was observed in the rate of abdominal CT scans between the FAST group (52.4%) and the standard care group (54.6%).
- One case of missed intra-abdominal injury occurred in the FAST group, versus none in the control group.
- There were no significant differences in ED length of stay or hospital charges between the two groups.
Conclusions:
- The use of FAST in hemodynamically stable children with blunt torso trauma did not improve clinical care or resource utilization compared to standard care alone.
- These findings do not support the routine use of FAST in the initial evaluation of pediatric patients with blunt torso trauma.
- Further research may be needed to identify specific subgroups of pediatric trauma patients who might benefit from FAST examination.
Importance:
The utility of the focused assessment with sonography for trauma (FAST) examination in children is unknown.
Objective:
To determine if the FAST examination during initial evaluation of injured children improves clinical care.
Design, Setting, And Participants:
A randomized clinical trial (April 2012-May 2015) that involved 975 hemodynamically stable children and adolescents younger than 18 years treated for blunt torso trauma at the University of California, Davis Medical Center, a level I trauma center.
Interventions:
Patients were randomly assigned to a standard trauma evaluation with the FAST examination by the treating ED physician or a standard trauma evaluation alone.
Main Outcomes And Measures:
Coprimary outcomes were rate of abdominal computed tomographic (CT) scans in the ED, missed intra-abdominal injuries, ED length of stay, and hospital charges.
Results:
Among the 925 patients who were randomized (mean [SD] age, 9.7 [5.3] years; 575 males [62%]), all completed the study. A total of 50 patients (5.4%, 95% CI, 4.0% to 7.1%) were diagnosed with intra-abdominal injuries, including 40 (80%; 95% CI, 66% to 90%) who had intraperitoneal fluid found on an abdominal CT scan, and 9 patients (0.97%; 95% CI, 0.44% to 1.8%) underwent laparotomy. The proportion of patients with abdominal CT scans was 241 of 460 (52.4%) in the FAST group and 254 of 465 (54.6%) in the standard care-only group (difference, -2.2%; 95% CI, -8.7% to 4.2%). One case of missed intra-abdominal injury occurred in a patient in the FAST group and none in the control group (difference, 0.2%; 95% CI, -0.6% to 1.2%). The mean ED length of stay was 6.03 hours in the FAST group and 6.07 hours in the standard care-only group (difference, -0.04 hours; 95% CI, -0.47 to 0.40 hours). Median hospital charges were $46 415 in the FAST group and $47 759 in the standard care-only group (difference, -$1180; 95% CI, -$6651 to $4291).
Conclusions And Relevance:
Among hemodynamically stable children treated in an ED following blunt torso trauma, the use of FAST compared with standard care only did not improve clinical care, including use of resources; ED length of stay; missed intra-abdominal injuries; or hospital charges. These findings do not support the routine use of FAST in this setting.
Trial Registration:
clinicaltrials.gov Identifier: NCT01540318.
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