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FAST Exam Predicts the Likelihood of Failing Non-operative Management in Pediatric Solid Organ Injury: A Prospective ATOMAC Study
Paul McGaha II, MD1, Prasenjeet Motghare MPH1, Nilda M Garcia, MD2 , Karla A Lawson, PhD2, Amanda Barczyk, PhD2, Crystal S Langlais, MPH3, Maria E. Linnaus, MD4, R. Todd Maxson, MD5, James W Eubanks III, MD6, Adam C. Alder, MD7, David Tuggle, MD2, Todd A. Ponsky, MD8, Daniel J Ostlie, MD3, Shawn D. St. Peter, MD9, David M. Notrica, MD3, and Robert Letton, MD1. 1University of Oklahoma Health Science Center, Oklahoma City, OK, USA, 2Dell Children's Hospital, Austin, TX, USA, 3Phoenix Children's Hospital, Phoenix, AZ, USA, 4Mayo Clinic, Scottsdale, AZ, USA, 5Arkansas Children's Hospital, Little Rock, AR, USA 6University of Tennessee Health Science Center, Memphis, TN, USA 7Children's Medical Center, Dallas, TX, USA, 8Akron Children's Hospital, Cleveland, OH, USA, 9Children's Mercy Hospital, Kansas City, MO, USA.

Background: FAST exam has long been proven useful in the adult trauma population, however, its utility in the pediatric population is not as proven. Our goal was to evaluate the utility of a FAST exam in predicting the success of non-operative management (NOM) of blunt liver and/or spleen (BLSI) in the pediatric trauma population.

Methods: A prospective observational study of patients less than 18 years of age presenting to one of ten level-1 pediatric trauma centers (PTC) between April 2013 and January 2016 BLSI. 955 patients were enrolled and 333 had a FAST recorded. 185 were negative and 148 were positive. Sensitivity, specificity, positive and negative predictive predictive value, and odds ratios were calculated with respect to failure of NOM.

Results: The two groups were comparable in age, gender, race and mechanism. FAST had a negative predictive value (NPV) of 82% and positive predictive value (PPV) of 46%. The odds ratio of failing with a positive FAST exam was 5.7 (CI 3.3-9.8; p < 0.0001) and with a negative FAST was 0.17 (CI 0.1 0.3; p < 0.0001). The NPV and PPV of FAST was much higher with isolated spleen injuries than liver.

Conclusions: FAST is predictive of failure of NOM of BLSI. It may be useful clinically in determining which patients are at risk and should be monitored more closely in an intensive care setting.

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