• 
• 

Three Part Question

In [paediatric patients with blunt abdominal trauma] how sensitive and specific is [FAST (Focussed Assessment with Sonography in Trauma) scanning] for [diagnosing intra-abdominal free fluid]?

Clinical Scenario

A 8 year old boy present to your Emergency Department having sustained blunt abdominal trauma in a road traffic collision. You are familiar with the use of FAST in adult patients in similar situations, and wonder whether the investigation is useful in the paediatric patient.

Search Strategy

Ovid MEDLINE(R) In-Process & Other Non-Indexed Citations and Ovid MEDLINE(R) <1948 to Present>
focussed OR focused AND abdominal AND ultrasound OR sonography OR Ultrasonography OR ultrasonography AND trauma OR "Wounds and Injuries" AND "Pediatrics" OR "Child"

Search Outcome

27 papers were found of which 20 did not consider children specifically or were otherwise irrelevant.

Relevant Paper(s)

Author, date and country	Patient group	Study type (level of evidence)	Outcomes	Key results	Study Weaknesses
Sola JE et al. 2009 USA	3171 patients aged under 16 with blunt abdominal trauma, of whom 497 underwent both FAST and CT scan	Diagnostic cohort, retrospective	Sensitivity	50%	Not all patients in the study who underwent FAST also had CT.
			Specificity	91%
Soundappan SV et al. 2005 Australia	85 patients aged from 4 months to 16 years who sustained blunt abdominal trauma and underwent FAST scan and CT	Prospective, single-blinded study	Sensitivity	81%	Only 19 of 76 patients with negative FAST underwent CT scan.
			Specificity	100%
Soudack M et al. 2004 Israel	313 paediatric patients who had sustained multiple traumatic injuries	Retrospective	Sensitivity	92.5%	Many patients did not undergo any further investigation after negative FAST (assumed to be clear based on conservative management without complications)
			Specificity	97.2%
Coley BD et al. 2000 USA	107 haemodynamically stable children undergoing CT for blunt abdominal trauma, prospectively investigated using FAST	Prospective diagnostic cohort	Sensitivity	55%	Small numbers; also relatively early study - possibly not valid for comparison with current equipment and technique.
Mutabagani KH et al. 1999 USA	46 haemodynamically stable children undergoing investigation for suspected intraabdominal injury	Prospective diagnostic cohort	Sensitivity	30%	Small numbers; also relatively early study - possibly not valid for comparison with current equipment and technique.
			Specificity	100%
Patel JC & Tepas JJ 1999 USA	94 children who had undergone FAST reviewed with respect to their subsequent management requirements.	Retrospective diagnostic cohort.	Sensitivity	33%	Most children did not undergo CT - "gold standard" for purposes of comparison was need for surgery. Also relatively early study - possibly not valid for comparison with current equipment and technique.
			Specificity	95%

Comment(s)

Current research shows that FAST in this context has a high specificty. Sensitivity is much lower, but the data are highly varied. Further high-quality research using modern equipment and technique is required.

Clinical Bottom Line

FAST scan in children with blunt abdominal trauma is highly specific and can be used to rule-in free fluid without the need for exposure to radiation-based imaging.

References

1. Sola JE et al Pediatric FAST and elevated liver transaminases: An effective screening tool in blunt abdominal trauma. Journal of Surgical Research 2009;157(1):103-7
2. Soundappan SV et al. Diagnostic accuracy of surgeon-performed focused abdominal sonography (FAST) in blunt pediatric trauma. Injury 2005;36(8):970-5
3. Soudack M et al Experience with focused abdominal sonography for trauma (FAST) in 313 pediatric patients. Journal of Clinical Ultrasound 2004;32(2):53-61
4. Coley BD et al. Focused abdominal sonography for trauma (FAST) in children with blunt abdominal trauma. Journal of Trauma - Injury Infection & Critical Care 2000;48(5)902-6
5. Mutabagani KH et al. Preliminary experience with focused abdominal sonography for trauma (FAST) in children: Is it useful? Journal of Pediatric Surgery 1999;34(1):48-52
6. Patel JC & Tepas JJ The efficacy of focused abdominal sonography for trauma (FAST) as a screening tool in the assessment of injured children. Journal of Pediatric Surgery 1999;34(1):44-7
7. Thourani VH et al. Validation of surgeon-performed emergency abdominal ultrasonography in pediatric trauma patients. Journal of Pediatric Surgery 1998;33(2):322-88