Antonio Riera1, Harrison Hayward2, Cicero Torres Silva3, Lei Chen1. 1. From the Section of Pediatric EmergencyMedicine, Department of Pediatrics. 2. Department of Pediatrics. 3. Section of Pediatric Radiology, Department of Radiology and Biomedical Imaging, Yale University School of Medicine, New Haven, CT.
Abstract
BACKGROUND: The utility of the focused assessment with sonography in trauma (FAST) examination in hemodynamically stable pediatric blunt abdominal trauma (BAT) patients is controversial.We report our 3-year experience with FAST performance to detect greater than physiologic amounts of intraperitoneal fluid after BAT. METHODS: We performed a retrospective chart review of all FAST examinations performed from July 2015 to June 2018 at a level I pediatric trauma center. The main outcome of interest was the performance of a concerning FAST (cFAST) compared with a computed tomography scan diagnosis for greater than physiologic levels of free fluid (FF) and clinical follow-up. A cFAST was defined by the presence of any FF in the upper abdomen or by a moderate to large amount of FF present in the pelvis. The interobserver reliability of cFASTwas assessed with Cohen κ coefficient. Locations of FF were assessed. RESULTS: A total of 448 FAST cases were eligible for review. The median age was 11 years with 64% male. Thirty-one FAST examinations (6.9%) were positive for some amount of FF; 18 (4.0%) were cFASTs. In the cFAST group, 11 patients (61%) were hemodynamically stable. The cFAST had a sensitivity of 89% (95% confidence interval [CI], 65%-99%), specificity of 99% (95% CI, 98%-100%), positive predictive value of 89% (95% CI, 67%-97%), and negative predictive value of 99% (95% CI, 98%-100%). The positive and negative likelihood ratios were 191 (95% CI, 47-769) and 0.11 (95% CI, 0.03-0.41). The κ coefficient for cFASTwas 0.72 with 86% agreement. Free fluid on cFAST cases was observed in the pelvis (78%), right upper quadrant (44%), and left upper quadrant (44%). CONCLUSIONS: In pediatric BAT patients, a cFAST has acceptable sensitivity and remains a highly specific test to rule in greater than physiologic quantities of FF with confidence.
BACKGROUND: The utility of the focused assessment with sonography in trauma (FAST) examination in hemodynamically stable pediatric blunt abdominal trauma (BAT) patients is controversial.We report our 3-year experience with FAST performance to detect greater than physiologic amounts of intraperitoneal fluid after BAT. METHODS: We performed a retrospective chart review of all FAST examinations performed from July 2015 to June 2018 at a level I pediatric trauma center. The main outcome of interest was the performance of a concerning FAST (cFAST) compared with a computed tomography scan diagnosis for greater than physiologic levels of free fluid (FF) and clinical follow-up. A cFAST was defined by the presence of any FF in the upper abdomen or by a moderate to large amount of FF present in the pelvis. The interobserver reliability of cFASTwas assessed with Cohen κ coefficient. Locations of FF were assessed. RESULTS: A total of 448 FAST cases were eligible for review. The median age was 11 years with 64% male. Thirty-one FAST examinations (6.9%) were positive for some amount of FF; 18 (4.0%) were cFASTs. In the cFAST group, 11 patients (61%) were hemodynamically stable. The cFAST had a sensitivity of 89% (95% confidence interval [CI], 65%-99%), specificity of 99% (95% CI, 98%-100%), positive predictive value of 89% (95% CI, 67%-97%), and negative predictive value of 99% (95% CI, 98%-100%). The positive and negative likelihood ratios were 191 (95% CI, 47-769) and 0.11 (95% CI, 0.03-0.41). The κ coefficient for cFASTwas 0.72 with 86% agreement. Free fluid on cFAST cases was observed in the pelvis (78%), right upper quadrant (44%), and left upper quadrant (44%). CONCLUSIONS: In pediatric BAT patients, a cFAST has acceptable sensitivity and remains a highly specific test to rule in greater than physiologic quantities of FF with confidence.
Authors: Megan K Long; Mohammed K Vohra; Austin Bonnette; Pablo D Vega Parra; Sara K Miller; Emily Ayub; Henry E Wang; Marylou Cardenas-Turanzas; Richard Gordon; Irma T Ugalde; Myron Allukian; Hannah E Smith Journal: J Am Coll Emerg Physicians Open Date: 2022-01-27
Authors: Aaron E Kornblith; Newton Addo; Monica Plasencia; Ashkon Shaahinfar; Margaret Lin-Martore; Naina Sabbineni; Delia Gold; Lily Bellman; Ron Berant; Kelly R Bergmann; Timothy E Brenkert; Aaron Chen; Erika Constantine; J Kate Deanehan; Almaz Dessie; Marsha Elkhunovich; Jason Fischer; Cynthia A Gravel; Sig Kharasch; Charisse W Kwan; Samuel H F Lam; Jeffrey T Neal; Kathyrn H Pade; Rachel Rempell; Allan E Shefrin; Adam Sivitz; Peter J Snelling; Mark O Tessaro; William White Journal: JAMA Netw Open Date: 2022-03-01