nach oben

Pediatric Surgery International

Erschienen in:

25.08.2020 | Original Article

Test characteristics of focused assessment with sonography for trauma (FAST), repeated FAST, and clinical exam in prediction of intra-abdominal injury in children with blunt trauma

verfasst von: Hooman Bahrami-Motlagh, Fatemeh Hajijoo, Masoud Mirghorbani, Babak SalevatiPour, Maryam Haghighimorad

Erschienen in: Pediatric Surgery International | Ausgabe 10/2020

Einloggen, um Zugang zu erhalten

Abstract

Purpose

In children with blunt abdominal trauma (BAT), focused assessment of sonography in trauma (FAST) has been reported with low sensitivity, on the whole, in the detection of intra-abdominal injuries (IAI). The aim of the present study was to assess test characteristics of FAST using different strategies including repeated FAST (reFAST), and physical exam findings.

Methods

This retrospective study evaluated BAT pediatric patients with stable hemodynamics who underwent computed tomography (CT). Demographic data, initial physical examination, and results of FAST, reFAST (if done), and CT imaging were recorded. Different strategies of FAST were cross-tabulated with CT as the gold standard and test characteristics including sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy were interpreted.

Results

129 patients with a mean age of 8.6 ± 4.7 were studied and 74% were male. Comparing CT-positive and -negative groups, from the demographic and clinical findings, only positive physical exam (tenderness or ecchymosis) was significantly higher in the CT-positive group (59% vs. 17%; p < 0.01). In a multivariate analysis, positive FAST modality and clinical exam remained independent predictors for a positive CT result (likelihood ratios of 34.6 and 6.4, respectively). Out of the different diagnostic strategies for the prediction of IAI, the best overall performance resulted from the FAST–reFAST–tenderness protocol with sensitivity, specificity, PPV, NPV, and accuracy of 87%, 77%, 70%, 91%, and 81%.

Conclusion

For children with blunt abdominal trauma, physical examination plus FAST and reFAST as needed, seems to have reasonable sensitivity, specificity, and accuracy in detecting intra-abdominal injuries and may reduce the need for CT scans.

Nur mit Berechtigung zugänglich

Wegner S, Colletti JE, Van Wie D (2006) Pediatric blunt abdominal trauma. Pediatr Clin North Am 53(2):243–256CrossRef

Menaker J, Blumberg S, Wisner DH et al (2014) Use of the focused assessment with sonography for trauma (FAST) examination and its impact on abdominal computed tomography use in hemodynamically stable children with blunt torso trauma. J Trauma Acute Care Surg 77(3):427–432CrossRef

Brenner DJ, Hall EJ (2007) Computed tomography–an increasing source of radiation exposure. N Engl J Med 357(22):2277–2284CrossRef

Bode PJ, Edwards MJ, Kruit MC, van Vugt AB (1999) Sonography in a clinical algorithm for early evaluation of 1671 patients with blunt abdominal trauma. AJR Am J Roentgenol 172(4):905–911CrossRef

Sheng AY, Dalziel P, Liteplo AS, Fagenholz P, Noble VE (2013) Focused assessment with sonography in trauma and abdominal computed tomography utilization in adult trauma patients: trends over the last decade. Emerg Med Int 2013:678380–678380CrossRef

Calder BW, Vogel AM, Zhang J et al (2017) Focused assessment with sonography for trauma in children after blunt abdominal trauma: a multi-institutional analysis. J Trauma Acute Care Surg 83(2):218–224CrossRef

Emery KH, McAneney CM, Racadio JM, Johnson ND, Evora DK, Garcia VF (2001) Absent peritoneal fluid on screening trauma ultrasonography in children: a prospective comparison with computed tomography. J Pediatr Surg 36(4):565–569CrossRef

Holmes JF, Gladman A, Chang CH (2007) Performance of abdominal ultrasonography in pediatric blunt trauma patients: a meta-analysis. J Pediatr Surg 42(9):1588–1594CrossRef

Puchalski AL, Magill C (2018) Imaging gently. Emerg Med Clin North Am 36(2):349–368CrossRef

10.

Berona K, Kang T, Rose E (2016) Pelvic free fluid in asymptomatic pediatric blunt abdominal trauma patients: a case series and review of the literature. J Emerg Med 50(5):753–758CrossRef

11.

Fox JC, Boysen M, Gharahbaghian L et al (2011) Test characteristics of focused assessment of sonography for trauma for clinically significant abdominal free fluid in pediatric blunt abdominal trauma. Acad Emerg Med Off J Soc Acad Emerg Med 18(5):477–482CrossRef

12.

Mendelson KGFM (2007) Pediatric injuries: prevention to resolution. Surg Clin North Am 87:207–228CrossRef

13.

Rice HE, Frush DP, Farmer D, Waldhausen JH, Committee AE (2007) Review of radiation risks from computed tomography: essentials for the pediatric surgeon. J Pediatr Surg 42(4):603–607CrossRef

14.

Rozycki GS (1995) Abdominal ultrasonography in trauma. Surg Clin North Am 75(2):175–191CrossRef

15.

McKenney MG, Martin L, Lentz K et al (1996) 1,000 consecutive ultrasounds for blunt abdominal trauma. J Trauma 40(4):607–612CrossRef

16.

Scaife ER, Fenton SJ, Hansen KW, Metzger RR (2009) Use of focused abdominal sonography for trauma at pediatric and adult trauma centers: a survey. J Pediatr Surg 44(9):1746–1749CrossRef

17.

Katz S, Lazar L, Rathaus V, Erez I (1996) Can ultrasonography replace computed tomography in the initial assessment of children with blunt abdominal trauma? J Pediatr Surg 31(5):649–651CrossRef

18.

Thourani VH, Pettitt BJ, Schmidt JA, Cooper WA, Rozycki GS (1998) Validation of surgeon-performed emergency abdominal ultrasonography in pediatric trauma patients. J Pediatr Surg 33(2):322–328CrossRef

19.

Carter JW, Falco MH, Chopko MS, Flynn WJ Jr, Wiles Iii CE, Guo WA (2015) Do we really rely on fast for decision-making in the management of blunt abdominal trauma? Injury 46(5):817–821CrossRef

20.

Cheung KS, Wong HT, Leung LP, Tsang TC, Leung GK (2012) Diagnostic accuracy of Focused Abdominal Sonography for Trauma in blunt abdominal trauma patients in a trauma centre of Hong Kong. Chin J Traumatol = Zhonghua chuang shang za zhi. 15(5):273–278PubMed

21.

Coley BD, Mutabagani KH, Martin LC et al (2000) Focused abdominal sonography for trauma (FAST) in children with blunt abdominal trauma. J Trauma 48(5):902–906CrossRef

22.

Holmes JF, Brant WE, Bond WF, Sokolove PE, Kuppermann N (2001) Emergency department ultrasonography in the evaluation of hypotensive and normotensive children with blunt abdominal trauma. J Pediatr Surg 36(7):968–973CrossRef

23.

Schoneberg C, Tampier S, Hussmann B, Lendemans S, Waydhas C (2014) Diagnostic management in paediatric blunt abdominal trauma - a systematic review with metaanalysis. Zentralbl Chir 139(6):584–591PubMed

24.

Soudack M, Epelman M, Maor R et al (2004) Experience with focused abdominal sonography for trauma (FAST) in 313 pediatric patients. J Clin Ultrasound JCU 32(2):53–61CrossRef

25.

Dolich MO, McKenney MG, Varela JE, Compton RP, McKenney KL, Cohn SM (2001) 2,576 ultrasounds for blunt abdominal trauma. J Trauma 50(1):108–112CrossRef

26.

Soundappan SVS, Holland AJA, Cass DT, Lam A (2005) Diagnostic accuracy of surgeon-performed focused abdominal sonography (FAST) in blunt paediatric trauma. Injury 36(8):970–975CrossRef

Titel: Test characteristics of focused assessment with sonography for trauma (FAST), repeated FAST, and clinical exam in prediction of intra-abdominal injury in children with blunt trauma
verfasst von: Hooman Bahrami-Motlagh
Fatemeh Hajijoo
Masoud Mirghorbani
Babak SalevatiPour
Maryam Haghighimorad
Publikationsdatum: 25.08.2020
Verlag: Springer Berlin Heidelberg
Erschienen in: Pediatric Surgery International / Ausgabe 10/2020
Print ISSN: 0179-0358
Elektronische ISSN: 1437-9813
DOI: https://doi.org/10.1007/s00383-020-04733-w

Update Pädiatrie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

Newsletter bestellen

Springer Medizin

Test characteristics of focused assessment with sonography for trauma (FAST), repeated FAST, and clinical exam in prediction of intra-abdominal injury in children with blunt trauma