VALIDATION OF SURGEON-PERFORMED EMERGENCY ABDOMINAL ULTRASONOGRAPHY IN PEDIATRIC TRAUMA PATIENTS

Background/Purpose: The focused assessment for the sonographic evaluat ion of trauma patients (FAST) in adults is effective in detecting intr aperitoneal and intrapericardial fluid and can be performed quickly by surgeons in the emergency department (ED). The authors sought to vali date the accuracy of FAST performed by surgeons during ED resuscitatio n of pediatric trauma patients. Methods: Patients were assigned to one of three groups based on standard clinical criteria: immediate surger y, abdominal computed tomography (CT), or observation alone. FAST was then performed in the ED by a surgery resident (postgraduate year 3 or higher) or an attending trauma surgeon. Four views were used to asses s the possible presence of fluid in the pericardial, subphrenic, subhe patic, and pelvic spaces. Time needed to conduct FAST was noted. Prese nce of peritoneal or pericardial fluid by FAST was compared with that determined by CT or surgery. Sensitivity, specificity, and predictive values were calculated. For those who did not undergo CT or surgery FA ST findings were compared with the clinical course. Results: Technical ly adequate studies could be performed on 192 of 196 eligible children . Their ages ranged from 3 months to 14 years (mean, 6.9 years); 119 w ere boys (62%), and 188 (98%) had sustained a blunt injury. FAST was p erformed in a mean time of 3.9 minutes (range, 1-17 minutes). All FAST examinations were reviewed by our senior surgeon-sonographer (GSR). I nterrater agreement between the performing and reviewing surgeon-sonog rapher was 100%. Sixty (31%) patients underwent either abdominal CT (n = 56; mean Injury Severity Score (ISS), 9.6) or immediate operation ( n = 4; mean ISS, 18.8). Of the 10 patients with verified presence of i ntraperitoneal fluid, eight had positive and two had false-negative FA ST examination results. Of the 50 patients with verified absence of in traperitoneal fluid, none had a positive FAST (ie, no false-positives) ; sensitivity was 80%; specificity, 100%; predictive value positive, 1 00%; predictive value negative, 96%. None of the 132 patients followed up clinically without CT or surgery (mean ISS, 4.5) had fluid documen ted by FAST, and all did well. Conclusions: The focused assessment for the sonographic evaluation of pediatric blunt trauma patients perform ed by surgical residents and attendings in the ED rapidly and accurate ly predicted the presence or absence of intraperitoneal fluid. The FAS T is a potentially valuable tool to rapidly prioritize the need for la parotomy in the child with multiple injuries and extraabdominal source s of bleeding. Copyright a 1998 by W.B. Saunders Company.