Focused Abdominal Sonography for Trauma (FAST) in Children with Blunt Abdominal Trauma

TLDR

FAST is well documented in adults but its use in pediatric blunt abdominal trauma remains less established. The study tested whether FAST and CT are equivalent imaging modalities for pediatric blunt abdominal trauma. One hundred seven hemodynamically stable children undergoing CT for blunt abdominal trauma were prospectively evaluated with FAST to compare its ability to detect free intraperitoneal fluid against CT. Among 32 CT‑positive patients, FAST detected free fluid in 12, missed 10 solid‑organ injuries, yielding a sensitivity of 0.55 and NPV of 0.50, indicating insufficient performance for screening.

Abstract

Background Focused abdominal sonography for trauma (FAST) has been well reported in adults, but its applicability in children is less well established. We decided to test the hypothesis that FAST and computed tomography (CT) are equivalent imaging studies in the setting of pediatric blunt abdominal trauma. Methods One hundred seven hemodynamically stable children undergoing CT for blunt abdominal trauma were prospectively investigated using FAST. The ability of FAST to predict injury by detecting free intraperitoneal fluid was compared with CT as the imaging standard. Results Thirty-two patients had CT documented injuries. There were no late injuries missed by CT. FAST detected free fluid in 12 patients. Ten patients had solid organ injury but no free fluid and, thus, were not detected by FAST. The sensitivity of FAST relative to CT was only 0.55 and the negative predictive value was only 0.50. Conclusion FAST has insufficient sensitivity and negative predictive value to be used as a screening imaging test in hemodynamically stable children with blunt abdominal trauma.