Focused Assessment with Sonography in Trauma (FAST) performance in paediatric conflict injury

To evaluate the efficacy of Focused Assessment with Sonography in Trauma (FAST) in a paediatric population with a substantial proportion of penetrating abdominal injuries.

FAST and computed tomography (CT) abdomen findings were compared for 98 children who presented to Camp Bastion during the war in Afghanistan in 2011. FAST performance was compared to the reference standard of free fluid detected on CT. Whether children presented alone or as part of a group was also ascertained from the radiology database.

Of the 98 patients, 20 had free fluid on CT and 15 were FAST positive. Fourteen of the 98 (14%) had penetrating wounds to the abdominal cavity. For the whole cohort FAST sensitivity was 65% (41-85%) and specificity 97% (91-100%). For those with penetrating abdominal injury sensitivity was 64% (31-89%) and specificity was 100% (40-100%). In total, 45% arrived at the same time as another casualty, and 30% arrived with other injured children.

FAST performance in this population was similar to that reported in the context of paediatric blunt trauma, with high specificity for intra-abdominal free fluid. This is the first time this has been demonstrated in a cohort containing children with penetrating abdominal trauma. A substantial proportion of children presented as part of a group, necessitating simultaneous triage of multiple injured patients. FAST has a role to play in conflict medicine and mass casualty scenarios where rapid access to CT may not be feasible.