Preliminary experience with focused abdominal sonography for trauma (FAST)children: Is it useful?

Background/Purpose: Most pediatric surgeons and pediatric radiologists cons ider computed tomography (CT) the best radiological test for the evaluation of children with suspected intraabdominal injury. The majority of injured children evaluated with CT will be found to have a normal scan. Focused abd ominal sonography for trauma (FAST) has been shown to be a useful screening test in the evaluation of adult patients with suspected intraabdominal inj ury Limited data exist regarding the use of FAST in children. Our aim was t o evaluate the usefulness of FAST as a screening test in the evaluation of children with suspected intraabdominal injury in an attempt to minimize the number of normal CT scans performed. Methods: Hemodynamically stable children evaluated for suspected intraabdom inal injury were prospectively screened with FAST. FAST, real-time sonograp hy at four sites, was performed by staff pediatric radiologists. The averag e duration of the examination was 2 minutes. Positive and negative FAST sca n findings were defined prospectively. The result of each FAST was recorded (positive or negative) and then all patients underwent CT as a control. Al l management decisions were based on CT results. Results: Forty-six patients were included in the study. FAST identified fou r children with positive findings (free intraperitoneal fluid), whereas CT showed 13 children with injuries (nine with associated free intraperitoneal fluid and four with only solid organ injury and no associated intraperiton eal fluid). There were nine false-negative and no false-positive FAST scans . The sensitivity of FAST was 0.3 and the specificity was 1.0. Injuries mis sed by FAST included liver laceration, adrenal hematoma, renal laceration, small bowel injury and splenic laceration. Conclusion: Preliminary results suggest that FAST alone is not a useful scr eening test in the evaluation of children with suspected intraabdominal inj ury. J Pediatr Surg 34:48-54. Copyright (C) 1999 by W.B. Saunders Company.