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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

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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.

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References

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

    Article  Google Scholar 

  2. 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):427–432

    Article  Google Scholar 

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

    Article  CAS  Google Scholar 

  4. 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):905–911

    Article  CAS  Google Scholar 

  5. 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 2013:678380–678380

    Article  Google Scholar 

  6. 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):218–224

    Article  Google Scholar 

  7. 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):565–569

    Article  CAS  Google Scholar 

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

    Article  Google Scholar 

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

    Article  Google Scholar 

  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):753–758

    Article  Google Scholar 

  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):477–482

    Article  Google Scholar 

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

    Article  Google Scholar 

  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):603–607

    Article  Google Scholar 

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

    Article  CAS  Google Scholar 

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

    Article  CAS  Google Scholar 

  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):1746–1749

    Article  Google Scholar 

  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):649–651

    Article  CAS  Google Scholar 

  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):322–328

    Article  CAS  Google Scholar 

  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):817–821

    Article  Google Scholar 

  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):273–278

    PubMed  Google Scholar 

  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):902–906

    Article  CAS  Google Scholar 

  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):968–973

    Article  CAS  Google Scholar 

  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):584–591

    CAS  PubMed  Google Scholar 

  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):53–61

    Article  Google Scholar 

  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):108–112

    Article  CAS  Google Scholar 

  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):970–975

    Article  CAS  Google Scholar 

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Acknowledgements

The authors would like to thank the Clinical Research Development Unit (CRDU) of Loghman Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran for their cooperation and assistance throughout the period of study.

Funding

No funding or sponsorship was received for this study or publication of this article.

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Authors and Affiliations

  1. Department of Radiology, Loghman Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran

    Hooman Bahrami-Motlagh, Fatemeh Hajijoo, Babak SalevatiPour & Maryam Haghighimorad

  2. Clinical Research Development Unit (CRDU) of Loghman Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran

    Hooman Bahrami-Motlagh, Fatemeh Hajijoo, Babak SalevatiPour & Maryam Haghighimorad

  3. Department of Public Health, Tehran University of Medical Sciences, Tehran, Iran

    Masoud Mirghorbani

  4. Department of Ophthalmology, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran

    Masoud Mirghorbani

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  1. Hooman Bahrami-Motlagh
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  4. Babak SalevatiPour
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  5. Maryam Haghighimorad
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Contributions

Concept and design: HB, BS, and MH; data acquisition: HB, FH, and MM; data analysis/interpretation: HB and MM, FH; drafting manuscript: MM and FH; critical revision of manuscript: HB, BS, and MH; supervision: HB. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Fatemeh Hajijoo.

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Conflict of interest

Hooman Bahrami-Motlagh, Fatemeh Hajijoo, Masoud Mirghorbani, Babak Salevatipour, and Maryam Haghighimorad had nothing to disclose.

Ethical approval

All named authors meet the International Committee of Medical Journal Editors (ICMJE) criteria for authorship for this article, take responsibility for the integrity of the work as a whole, and have given their approval for this version to be published.

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Bahrami-Motlagh, H., Hajijoo, F., Mirghorbani, M. et al. 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. Pediatr Surg Int 36, 1227–1234 (2020). https://doi.org/10.1007/s00383-020-04733-w

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