The aim of this study was to evaluate the variability of clinician-performed Focused Assessment with Sonography for Trauma (FAST) examinations and its impact on abdominal computed tomography (AbCT) use in hemodynamically stable children
with blunt torso trauma (BTT). The FAST is used with variable frequency in children
We performed a planned secondary analysis of children
(<18 years) with BTT. Patients with a Glasgow Coma Scale (GCS) score of less than 9, those with hypotension, and those taken directly to the operating suite were excluded. Clinicians documented their suspicion for intra-abdominal injury
(IAI) as very low, less than 1%; low, 1% to 5%; moderate, 6% to 10%; high, 11% to 50%; or very high, greater than 50%. We determined the relative risk (RR) for AbCT use based on undergoing a FAST examination
in each of these clinical suspicion strata.
Of 6,468 (median age, 11.8 years; interquartile range, 6.3–15.5 years) children
who met eligibility, 887 (13.7%) underwent FAST examination
before CT scan. A total of 3,015 (46.6%) underwent AbCT scanning, and 373 (5.8%) were diagnosed with IAI. Use of the FAST increased as clinician suspicion for IAI increased, 11.0% with less than 1% suspicion for IAI, 13.5% with 1% to 5% suspicion, 20.5% with 6% to 10% suspicion, 23.2% with 11% to 50% suspicion, and 30.7% with greater than 50% suspicion. The patients in whom the clinicians had a suspicion of IAI of 1% to 5% or 6% to 10% were significantly less likely to undergo a CT scan if a FAST examination
was performed: RR, 0.83 (0.67–1.03); RR, 0.81 (0.72–0.91); RR, 0.85 (0.78–0.94); RR, 0.99 (0.94–1.05); and RR, 0.97 (0.91–1.05) for patients with clinician suspicion of IAI of less than 1%, 1% to 5%, 6% to 10%, 11% to 50%, and greater than 50%, respectively.
The FAST examination
is used in a relatively small percentage of children
with BTT. Use increases as clinician suspicion for IAI increases. Patients with a low or moderate clinician suspicion of IAI are less likely to undergo AbCT if they receive a FAST examination
. A randomized controlled trial is required to more precisely determine the benefits and drawbacks of the FAST examination
in the evaluation of children
LEVEL OF EVIDENCE
Prognostic and epidemiologic study, II.