Using Focused Assessment with Sonography for Trauma (FAST) in the emergency department to assess children presenting with possible abdominal trauma does not appear to improve use of resources or care, according to a study published in JAMA.
"A lot of our work has looked at the appropriate use of CT scans in injured patients," lead author James Holmes, MD, MPH, professor of emergency medicine at UC Davis Medical Center in Sacramento, Ca, said in a release. "At least in the adult trauma population, there's evidence that you can use ultrasound to safely decrease CT use. One of the big questions has been whether that holds true for children, too."
The researchers performed a randomized clinical trial of 925 patients to determine if the FAST examination of children in the ED improved standard of care. Their mean age was 9.7 years; 62% were male. The patients were randomized to be in the FAST or no-FAST group.
The results showed that 50 of the 925 patients (5.4%) were diagnosed with intra-abdominal injuries; 40 (80%) had intraperitoneal fluid as detected by abdominal CT scan, and nine patients (0.97%) underwent laparotomy.
Other findings included:
|FAST Group||No-FAST Group|
|Incidence proportion of patients with abdominal CT scans||241/460 (52.4%)||254/465 (54.6%)|
|Missed IAI injury||1||0|
|Average length of stay in ER||6.03 hours||6.07 hours|
"We were surprised that the routine use of FAST did not show any significant differences," senior study author Nathan Kuppermann, MD, MPH, said in the release. "The use of FAST compared with our standard trauma care did not decrease CT scan use, improve resource use, emergency department length-of-stay, safety or hospital charges." The researchers suggest a large, multicenter randomized clinical trial would more definitively answer the question regarding the usefulness of the FAST examination in children after blunt torso trauma.