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Updated: Jan 8, 2026
Focused Assessment with Sonography for Trauma FAST Exam: Image Acquisition
Published on: September 22, 2023
Abdominal ultrasound (FAST) in hemodynamically stable children with blunt abdominal trauma: study protocol for a
James F Holmes1, Daniel J Tancredi2, Kenneth M Kelley3
1Department of Emergency Medicine, University of California, Davis School of Medicine, Sacramento, CA, USA. jfholmes@ucdavis.edu.
Insights
This study investigates if the Focused Assessment with Sonography for Trauma (FAST) examination can safely reduce computed tomography (CT) use in children with abdominal injuries. Results will guide routine clinical practice for pediatric trauma evaluation.
Area of Science:
- Pediatric Emergency Medicine
- Diagnostic Imaging
- Trauma Surgery
Background:
- Intra-abdominal injuries (IAI) are a major cause of death in pediatric trauma.
- Over-reliance on abdominal computed tomography (CT) raises concerns about radiation exposure in children.
- The Focused Assessment with Sonography for Trauma (FAST) examination may reduce CT use, but its utility in children requires further study.
Purpose of the Study:
- To determine if the FAST examination safely reduces abdominal CT utilization in children with blunt abdominal trauma.
- To provide evidence for the routine implementation of the FAST examination in pediatric trauma care.
Main Methods:
- A multicenter, randomized controlled trial involving 3194-4346 children with blunt abdominal trauma.
- Participants randomized to FAST examination plus routine care or routine care alone.
- Primary outcomes include proportion of abdominal CT use within 24 hours and missed/delayed IAI diagnoses.
Main Results:
- This section is not available in the provided abstract.
Conclusions:
- The study aims to establish whether the FAST examination leads to a safe decrease in CT scans for injured children.
- Definitive evidence will be provided on the routine use of FAST in the initial evaluation of pediatric blunt abdominal trauma.
Background:
Hemorrhage from intra-abdominal injuries (IAI) is a leading cause of traumatic deaths in children. Concern over misdiagnosing IAIs has resulted in excessive use of abdominal computed tomography (CT). Despite its many benefits, CT presents risks to children most notably radiation-induced malignancies. Thus, we must safely limit abdominal CT evaluation to those at non-negligible risk. The focused assessment with sonography for trauma (FAST) examination uses abdominal ultrasonography to detect the presence of intraperitoneal fluid in injured patients and may decrease abdominal CT use in some children. Limited and conflicting data exists on the utility of the FAST examination in children. A large multicenter study is thus necessary to determine if the FAST examination should routinely be included in the diagnostic evaluation of injured children.
Methods:
This is a multicenter, randomized controlled clinical trial to assess the impact of the FAST examination on the initial evaluation of children with blunt abdominal trauma. Enrolled participants will be randomized 1:1 to the FAST examination plus routine care or routine care alone during their initial emergency department (ED) evaluation. The study will enroll 3194 (initial sample size) to 4346 (second sample size) children at six diverse sites. The primary outcomes are as follows: (1) The proportion of abdominal CT in the initial 24 h of care and (2) the proportion of missed or delayed diagnoses of IAIs. Secondary outcomes include (1) ED length of stay, (2) hospitalization proportion and length of hospital stay, (3) physician suspicion of IAI, (4) the proportion of abdominal CT use in the subgroup of children 0 to 3 years old, and (5) laparotomy proportion. Hospitalized participants will be followed through their stay, and guardians of those discharged from the ED will be contacted after 1 week to assess their status.
Discussion:
The study will determine if the FAST examination results in a safe reduction of CT use in injured children and will provide definitive evidence if the FAST examination should be routinely implemented in the initial evaluation of children with blunt abdominal trauma.
Trial Registration:
ClinicalTrials.gov NCT05910567. Registered on May 9, 2023.
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