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Prospective Evaluation of Focused Abdominal Sonography for Trauma (FAST) in Children Following Blunt Abdominal Trauma
Christian J. Streck, Jr., MD1, Bennett Calder, MD1, Adam M. Vogel, MD2, Eunice Y. Huang, MD3, Kate B. Savoie, MD3, MS, Matthew T. Santore, MD4, KuoJen Tsao, MD5, Tiffany G. Ostovar-Kermani, MD, MPH5, Richard Falcone, MD6, Suzanne Moody6, M. Sidney Dassinger, MD7, John Recicar, MD7, Jeffrey H. Haynes, MD8, Martin L. Blakely, MD9, Robert T. Russell, MD, MPH10, Bindi J. Naik-Mathuria, MD11, Shawn D. St. Peter, MD12, David P. Mooney, MD13, Chinwendu Onwubiko, MD13, Jeffrey S. Upperman, MD14, J Zagory, MD14, Jingwen Zhang1, Patrick D. Mauldin, PhD1.1The Medical University of South Carolina, Charleston, SC, USA, 2Washington University in St. Louis School of Medicine, Saint Louis Children’s Hospital, St. Louis, MO, USA, 3University of Tennessee-Memphis Health Science Center, Memphis, TN, USA, 4Children’s Healthcare of Atlanta, Emory School of Medicine, Atlanta, GA, USA, 5McGovern Medical School, The University of Texas Health Science Center, Houston, TX, USA, 6Cincinnati Children’s Hospital, Cincinnati, OH, USA, 7Arkansas Children’s Hospital, Little Rock, AK, USA, 8Children’s Hospital of Richmond at VCU, Richmond, VA, USA, 9Vanderbilt Children’s Hospital, Nashville, TN, USA, 10Children’s Hospital of Alabama, Birmingham, AL, USA, 11Texas Children’s Hospital, Houston, TX, USA, 12Children’s Mercy Hospital, Kansas City, MO, USA, 13Boston Children’s Hospital, Boston MA, 14Children’s Hospital Los Angeles, Los Angeles, CA, USA.

Background: The utility of FAST in children is poorly defined with considerable practice variation. Our purpose was to investigate the role of FAST for intraabdominal injury(IAI) and IAI requiring acute intervention(IAI-I) in children following blunt abdominal trauma(BAT).

Methods: We prospectively enrolled children age<16 years following BAT at 14 Level-One Pediatric Trauma Centers over 1-year. Patients were excluded who presented >6 hours after injury, underwent abdominal CT scan before transfer, or with isolated head/extremity trauma.

Results: 2188 children(median age 8 years) were included. 829 received a FAST (37.9%) and 340 patients underwent a subsequent CT or surgery. 97 of these 340 patients (29%) had an IAI and 27 received an acute intervention. FAST test characteristics and imaging use are seen in Figure 1. CT use following FAST was 41.0% versus 44.2% for the overall population. There were 31 liver, 14 spleen, 6 kidney, 6 mesenteric, 9 bowel, and 4 other injuries among the false negative FAST. Fifteen children with negative FAST received acute intervention: 9 transfusions, 8 intestinal repairs and 2 angioembolizations. Among 27 patients with true positive FAST exams, 12 received intervention(7 surgeries). No patient underwent intervention prior to CT. There was low correlation between FAST and CT utilization (r = -0.050, p < 0.001).

Conclusions: As currently employed, FAST has a low sensitivity for IAI, misses IAI-I and rarely impacts management in pediatric BAT.

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