FAST EXAM IN
PEDIATRIC PATIENTS
Evidence in the ED
March 5, 2014
Sarah Cavallaro PGY-3
Introduction
• The role of the FAST exam in Pediatric Trauma is unclear
• Review 4 studies that set the stage for current thinking
• Share my thoughts on how I wish these were done
• A HUPISM for future practice
Paper #1
• Jateen C. Patel and J.J. Tepas III. The Efficacy of Focused Abdominal Sonography for
Trauma (FAST) as a Screening Tool in Assessment of Injured Children. Journal of Pediatric
Surgery, Vol34,No 1 (January), 1999: pp 44-47
• Study Type: Retrospective chart review
• Subjects: Children (11.3yo mean) with Suspected Blunt
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•
•
•
Torso Trauma who received FAST exam
Hemodynamically unstable patients: Included (but
limited n=2)
N: 94
Ultrasonographer: Radiology
Gold Standard: None
Results
Author's Conclusion
• Specificity 95%, Sensitivity 33%
• This “excellent specificity” combined with clinical
examination allowed avoidance of “additional abdominal
imaging”
Paper #2
• Coley et al. Focused abdominal sonography for trauma (FAST) in children with blunt
abdominal trauma. J Trauma. 2000 May;48(5):902-6.
• Study Type: Prospective Study
• Subjects: Children (7.9yo mean) with Suspected Blunt
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•
•
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Torso Trauma who were to receive CT
Hemodynamically unstable patients: Excluded
N: 107
Ultrasonographer: Radiology
Gold Standard: CT
Results
Author's Conclusions
• Specificity 0.83, Sensitivity 0.55
• Not an “appropriate” imaging study for hemodynamically
stable children with concern for blunt abdominal injury
• Should not replace CT
Paper #3
• Soudack et al. Experience with focused abdominal sonography for trauma (FAST) in
313 pediatric patients. J Clin Ultrasound. 2004 Feb;32(2):53-61.
• Study Type: Retrospective Chart Review
• Subjects: Children (7.1yo mean) with Suspected Blunt
•
•
•
•
Torso Trauma who had received FAST exam
Hemodynamically unstable patients: Included
N: 313
Ultrasonographer: Radiology *also evaluated for
parenchymal injury or retroperitoneal fluid
Gold Standard: None
Results
Results
Author's Conclusions
• Specificity 97.2% Sensitivity 92.5%
• The clinical significance of blunt abdominal injuries with
no FF must be established
• FAST Exam can be useful in patients with a normal
physical exam to eliminate the need for CT
• A positive FAST exam should then go to CT if stable or
the OR if unstable
Paper #4
• Fox JC et al., Test characteristics of focused assessment of sonography for trauma for
clinically significant abdominal free fluid in pediatric blunt abdominal trauma. Acad
Emerg Med. 2011 May;18(5):477-82.
• Study Type: Prospective
• Subjects: All blunt abdominal trauma patients aged 0•
•
•
•
17yo (about ½ age 13-17)
Hemodynamically unstable patients: Included (n=1)
N: 357
Ultrasonographer: EM Residents, EM attendings, EM
Ultrasound Fellows, surgeons
Gold Standard: CT (with moderate or severe FF) or
Laparotomy
Results
Results
Author's Conclusion
• Sensitivity 52%, Specificity 95% for clinically significant
FF
• Sensitivity 20%, Specificity 98% for any FF
• A positive FAST exam suggests hemoperitoneum while a
negative FAST exam is not useful in the setting of a
pediatric patient with blunt abdominal injury
My Thoughts
• Studying a very different use of the FAST exam
• Most studies do not examine our use of FAST in a
pediatric population
• Need better reporting on the clinical significance of injury
that presents with a negative FAST
• Use would require culture change
• Okay Byron, let’s hear your thoughts
HUPISM
• If positive, a FAST exam may still be helpful to locate the
source of bleeding in blunt traumatic pediatric patients
presenting with hemorrhagic shock. It is not however a
study that can replace CT scan for diagnosis of all intraabdominal injury in hemodynamically stable pediatric
patients.
References
• Jateen C. Patel and J.J. Tepas III. The Efficacy of Focused Abdominal
Sonography for Trauma (FAST) as a Screening Tool in Assessment of
Injured Children. Journal of Pediatric Surgery, Vol34,No 1 (January),
1999: pp 44-47
• Coley et al. Focused abdominal sonography for trauma (FAST) in
children with blunt abdominal trauma. J Trauma. 2000 May;48(5):9026.
• Soudack et al. Experience with focused abdominal sonography for
trauma (FAST) in 313 pediatric patients. J Clin Ultrasound. 2004
Feb;32(2):53-61.
• Fox JC et al., Test characteristics of focused assessment of
sonography for trauma for clinically significant abdominal free fluid in
pediatric blunt abdominal trauma. Acad Emerg Med. 2011
May;18(5):477-82.