Fast exam in pediatric patients
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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

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FAST Exam in pediatric patients

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Fast exam in pediatric patients

FAST Exam in pediatric patients

Evidence in the ED

March 5, 2014

Sarah Cavallaro PGY-3


Introduction

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

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 Torso Trauma who received FAST exam

  • Hemodynamically unstable patients: Included (but limited n=2)

  • N: 94

  • Ultrasonographer: Radiology

  • Gold Standard: None


Results

Results


Author s conclusion

Author's Conclusion

  • Specificity 95%, Sensitivity 33%

  • This “excellent specificity” combined with clinical examination allowed avoidance of “additional abdominal imaging”


Paper 2

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 Torso Trauma who were to receive CT

  • Hemodynamically unstable patients: Excluded

  • N: 107

  • Ultrasonographer: Radiology

  • Gold Standard:CT


Results1

Results


Author s conclusions

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

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


Results2

Results


Results3

Results


Author s conclusions1

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

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. AcadEmerg 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


Results4

Results


Results5

Results


Author s conclusion1

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

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

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 intra-abdominal injury in hemodynamically stable pediatric patients.


References

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):902-6.

  • 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. AcadEmerg Med. 2011 May;18(5):477-82.


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