Abstract
Aim: To assess the sensitivity and specificity of FAST scans in pediatric trauma in a dedicated pediatric trauma centre. Method: A 3-year (2008-2011) analysis of prospectively collected data looking at the results of FAST scans compared to Computed Tomography (CT) or laparotomy findings. Results: There were 482 pediatric trauma calls of which 166 patients had suspected intra-abdominal injury. 163 patients underwent CT scans of which 89 (55%) had FAST scans prior to CT. 3 patients had FAST scans without CT; 1 patient went straight to theatre (positive FAST) and 2 patients died in the department before any further imaging. The sensitivity of FAST scans to detect abdominal injury is 23% and the specificity is 97%. The injuries missed on FAST scan were: liver lacerations (n = 3), splenic lacerations (n = 5), 1 combined liver and kidney injury and 1 combined splenic injury and small bowel perforation. Conclusions: FAST scans in trauma have a low sensitivity in pediatric patients with the possibility of missing significant intra-abdominal injury. They do not obviate the need for CT scan when clinical suspicion is high.
Highlights
The clinical use of Focused Assessment with Sonography in Trauma (FAST) scans has gained increasing acceptance in the management of adult trauma patients and is used in up to 96% of adult trauma centers in theHow to cite this paper: Skerritt, C., Haque, S. and Makin, E. (2014) Focused Assessment with Sonography in Trauma (FAST) Scans Are Not Sufficiently Sensitive to Rule out Significant Injury in Pediatric Trauma Patients
There were 482 pediatric trauma calls secondary to blunt trauma over a three year period. 166 patients had suspected intra-abdominal injuries, of these 163 patients had Computed Tomography (CT) scans. 89 (55%) received FAST scans prior to the CT. 3 further patients had FAST scans. 1 patient went straight to theatre due to haemodynamic instability and underwent a splenectomy, 2 patients were pronouced dead on arrival in the emergency department prior to any further imaging
The commonest mechanism of injury was road traffic accidents (n = 66) and reflecting our hospital’s inner city setting the majority of patients (75%) had been pedestrians hit by vehicles rather than passengers
Summary
The clinical use of Focused Assessment with Sonography in Trauma (FAST) scans has gained increasing acceptance in the management of adult trauma patients and is used in up to 96% of adult trauma centers in theHow to cite this paper: Skerritt, C., Haque, S. and Makin, E. (2014) Focused Assessment with Sonography in Trauma (FAST) Scans Are Not Sufficiently Sensitive to Rule out Significant Injury in Pediatric Trauma Patients. The clinical use of Focused Assessment with Sonography in Trauma (FAST) scans has gained increasing acceptance in the management of adult trauma patients and is used in up to 96% of adult trauma centers in the. (2014) Focused Assessment with Sonography in Trauma (FAST) Scans Are Not Sufficiently Sensitive to Rule out Significant Injury in Pediatric Trauma Patients. Its adoption into pediatric trauma centers is considerably less at 15% [1]. Debate still continues as to their accuracy in assessing pediatric trauma patients. Some centers favor formal ultrasound instead of FAST scans. Retzlaff et al showed that ultrasound was effective in managing 97% of pediatric patients who had suffered intra-abdominal injuries as a result of blunt abdominal trauma and that CT only influenced decision making in 1 out of their 35 patients [2]
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