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The Role of FAST In the Evaluation of the Pediatric Trauma Patient

Saturday, October 20, 2012: 8:19 AM
Versailles Ballroom (Hilton Riverside)
Desiree A. Steimer, MD1, John R. Taylor, MD1, Aurora Luna, MD2 and John M. Draus Jr., MD1, (1)Surgery, Kentucky Children's Hospital, Lexington, KY, (2)Radiology, Univeristy of Kentucky, Lexington, KY

Purpose: Compared to adults, the utility of focused abdominal sonography for trauma (FAST) in children remains less defined. We sought to determine the diagnostic accuracy and clinical utility of FAST in the pediatric trauma population.

Methods: Trauma registry data were used to identify pediatric trauma patients (≤14 yrs) between 2006 and 2011 who underwent FAST as part of their secondary survey. Demographics, injuries, FAST results, CT results, operative findings, and outcomes were reviewed.

Results: 452 children were evaluated at our Level I Pediatric Trauma Center. 19 were excluded due to incomplete records, leaving a study cohort of 433 pediatric trauma patients. The vast majority (99.3%) were victims of blunt trauma -- mostly MVA's (45.2%). The average age was 8.23 years. 49 patients had positive FAST exams. 5 were taken for laparotomy without additional imaging; the remainder underwent CT imaging. 32 children had intra-abdominal injuries consistent with FAST findings -- 66% were managed non-operatively. 384 patients had negative FAST exams. 219 children did not undergo CT sca; none of these had a missed abdominal injury. 165 FAST-negative patients received a CT scan. 22 patients were found to have abdominal injuries, and 5 required surgical intervention.

Conclusion: Compared to CT, FAST has a specificity of 0.97 and positive predictive value 0.94. As in adults, FAST is best utilized in the evaluation of unstable trauma patients. However, children rarely present in hypovolemia shock. FAST had a sensitivity of 0.55 for detecting free fluid and a negative predictive value of 0.77. FAST missed 37 injuries with free fluid (8 liver, 8 bowel, 2 spleen, 2 adrenal, 1 renal and 1 vascular) and 8 injuries without free fluid (5 spleen, 3 liver, and 1 renal) that were identified by CT. CT scan remains the best tool for abdominal evaluation of pediatric trauma patients.