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Natalie Gengel, Anna Petrova, Susette Coyle, Yi-Horng Lee, Joelle Pierre
Natalie Gengel, DO, Anna Petrova, MD, PhD, MPH, Susette Coyle1, Yi-Horng Lee, MD, Joelle Pierre, MD. Rutgers-Robert Wood Johnson Medical School, New Brunswick, NJ, USA.

BACKGROUND: There is continued interest in the ability for FAST to identify clinically significant blunt abdominal trauma (BAT) thereby avoiding the radiation from computerized tomography (CT).

METHODS: The data was collected retrospectively and stratified with respect to the agreement between FAST and CT. Group 1 equals agreement and Group 2 equals no agreement. Level of agreement was determined using Cohen’s Kappa (?) statistic. Descriptive statistics, including ANOVA and X2 were used to compare clinical factors. Factors with difference P<0.1 entered into multivariate logistic regression model.

RESULTS: Of the 123 children with BAT, 51.6% (n=62) showed agreement between the imaging (Group 1) and among those, majority (85.5%) had positive FAST and CT results. Most of the patients with BAT were male (n=92, 74.8%). We found no difference between Group 1 and 2 in age, gender, clinical presentation of trauma, signs of hemorrhage or shock and number of organs injured during trauma. Moderate agreement by kappa statistics between FAST and CT was seen when the US result was positive (? =0.4733, 95% Confidence Interval 0.3762-0.5702). The agreement was very poor (less than 15%) with negative US.

CONCLUSIONS: FAST exam identifies significant abdominal injuries in pediatric patients. Negative FAST does not rule out injury and can miss some solid organ injuries. However the clinical significance of these “missed” injuries varies. Further analysis may show that CT can be used more selectively.

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