Effect of abdominal ultrasound on clinical care, outcomes, and resource use among children with blunt torso trauma a randomized clinical trial

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Abstract

IMPORTANCE The utility of the focused assessment with sonography for trauma (FAST) examination in children is unknown. OBJECTIVE To determine if the FAST examination during initial evaluation of injured children improves clinical care. DESIGN, SETTING, AND PARTICIPANTS A randomized clinical trial (April 2012-May 2015) that involved 975 hemodynamically stable children and adolescents younger than 18 years treated for blunt torso trauma at the University of California, Davis Medical Center, a level I trauma center. INTERVENTIONS Patients were randomly assigned to a standard trauma evaluation with the FAST examination by the treating ED physician or a standard trauma evaluation alone. MAIN OUTCOMES AND MEASURES Coprimary outcomeswere rate of abdominal computed tomographic (CT) scans in the ED, missed intra-abdominal injuries, ED length of stay, and hospital charges. RESULTS Among the 925 patients who were randomized (mean [SD] age, 9.7 [5.3] years; 575 males [62%]), all completed the study. A total of 50 patients (5.4%, 95%CI, 4.0% to 7.1%) were diagnosed with intra-abdominal injuries, including 40 (80%; 95%CI, 66%to 90%) who had intraperitoneal fluid found on an abdominal CT scan, and 9 patients (0.97%; 95%CI, 0.44%to 1.8%) underwent laparotomy. The proportion of patients with abdominal CT scans was 241 of 460 (52.4%) in the FAST group and 254 of 465 (54.6%) in the standard care-only group (difference, -2.2%; 95%CI, -8.7%to 4.2%). One case of missed intra-abdominal injury occurred in a patient in the FAST group and none in the control group (difference, 0.2%; 95%CI, -0.6%to 1.2%). The mean ED length of stay was 6.03 hours in the FAST group and 6.07 hours in the standard care-only group (difference, -0.04 hours; 95%CI, -0.47 to 0.40 hours). Median hospital charges were $46 415 in the FAST group and $47 759 in the standard care-only group (difference, -$1180; 95%CI, -$6651 to $4291). CONCLUSIONS AND RELEVANCE Among hemodynamically stable children treated in an ED following blunt torso trauma, the use of FAST compared with standard care only did not improve clinical care, including use of resources; ED length of stay; missed intra-abdominal injuries; or hospital charges. These findings do not support the routine use of FAST in this setting.

Original languageEnglish (US)
Pages (from-to)2290-2296
Number of pages7
JournalJAMA - Journal of the American Medical Association
Volume317
Issue number22
DOIs
StatePublished - Jun 13 2017

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Torso
Randomized Controlled Trials
Ultrasonography
Wounds and Injuries
Abdominal Injuries
Hospital Charges
Length of Stay
Trauma Centers
Laparotomy

ASJC Scopus subject areas

  • Medicine(all)

Cite this

@article{560e81dff43e4d2f863017f61ad5a7e8,
title = "Effect of abdominal ultrasound on clinical care, outcomes, and resource use among children with blunt torso trauma a randomized clinical trial",
abstract = "IMPORTANCE The utility of the focused assessment with sonography for trauma (FAST) examination in children is unknown. OBJECTIVE To determine if the FAST examination during initial evaluation of injured children improves clinical care. DESIGN, SETTING, AND PARTICIPANTS A randomized clinical trial (April 2012-May 2015) that involved 975 hemodynamically stable children and adolescents younger than 18 years treated for blunt torso trauma at the University of California, Davis Medical Center, a level I trauma center. INTERVENTIONS Patients were randomly assigned to a standard trauma evaluation with the FAST examination by the treating ED physician or a standard trauma evaluation alone. MAIN OUTCOMES AND MEASURES Coprimary outcomeswere rate of abdominal computed tomographic (CT) scans in the ED, missed intra-abdominal injuries, ED length of stay, and hospital charges. RESULTS Among the 925 patients who were randomized (mean [SD] age, 9.7 [5.3] years; 575 males [62{\%}]), all completed the study. A total of 50 patients (5.4{\%}, 95{\%}CI, 4.0{\%} to 7.1{\%}) were diagnosed with intra-abdominal injuries, including 40 (80{\%}; 95{\%}CI, 66{\%}to 90{\%}) who had intraperitoneal fluid found on an abdominal CT scan, and 9 patients (0.97{\%}; 95{\%}CI, 0.44{\%}to 1.8{\%}) underwent laparotomy. The proportion of patients with abdominal CT scans was 241 of 460 (52.4{\%}) in the FAST group and 254 of 465 (54.6{\%}) in the standard care-only group (difference, -2.2{\%}; 95{\%}CI, -8.7{\%}to 4.2{\%}). One case of missed intra-abdominal injury occurred in a patient in the FAST group and none in the control group (difference, 0.2{\%}; 95{\%}CI, -0.6{\%}to 1.2{\%}). The mean ED length of stay was 6.03 hours in the FAST group and 6.07 hours in the standard care-only group (difference, -0.04 hours; 95{\%}CI, -0.47 to 0.40 hours). Median hospital charges were $46 415 in the FAST group and $47 759 in the standard care-only group (difference, -$1180; 95{\%}CI, -$6651 to $4291). CONCLUSIONS AND RELEVANCE Among hemodynamically stable children treated in an ED following blunt torso trauma, the use of FAST compared with standard care only did not improve clinical care, including use of resources; ED length of stay; missed intra-abdominal injuries; or hospital charges. These findings do not support the routine use of FAST in this setting.",
author = "{Holmes Jr}, {James F} and Kelley, {Kenneth M} and Wootton-Gorges, {Sandra L.} and Utter, {Garth H} and Abramson, {Lisa P.} and Rose, {John S} and Tancredi, {Daniel J} and Nathan Kuppermann",
year = "2017",
month = "6",
day = "13",
doi = "10.1001/jama.2017.6322",
language = "English (US)",
volume = "317",
pages = "2290--2296",
journal = "JAMA - Journal of the American Medical Association",
issn = "0002-9955",
publisher = "American Medical Association",
number = "22",

}

TY - JOUR

T1 - Effect of abdominal ultrasound on clinical care, outcomes, and resource use among children with blunt torso trauma a randomized clinical trial

AU - Holmes Jr, James F

AU - Kelley, Kenneth M

AU - Wootton-Gorges, Sandra L.

AU - Utter, Garth H

AU - Abramson, Lisa P.

AU - Rose, John S

AU - Tancredi, Daniel J

AU - Kuppermann, Nathan

PY - 2017/6/13

Y1 - 2017/6/13

N2 - IMPORTANCE The utility of the focused assessment with sonography for trauma (FAST) examination in children is unknown. OBJECTIVE To determine if the FAST examination during initial evaluation of injured children improves clinical care. DESIGN, SETTING, AND PARTICIPANTS A randomized clinical trial (April 2012-May 2015) that involved 975 hemodynamically stable children and adolescents younger than 18 years treated for blunt torso trauma at the University of California, Davis Medical Center, a level I trauma center. INTERVENTIONS Patients were randomly assigned to a standard trauma evaluation with the FAST examination by the treating ED physician or a standard trauma evaluation alone. MAIN OUTCOMES AND MEASURES Coprimary outcomeswere rate of abdominal computed tomographic (CT) scans in the ED, missed intra-abdominal injuries, ED length of stay, and hospital charges. RESULTS Among the 925 patients who were randomized (mean [SD] age, 9.7 [5.3] years; 575 males [62%]), all completed the study. A total of 50 patients (5.4%, 95%CI, 4.0% to 7.1%) were diagnosed with intra-abdominal injuries, including 40 (80%; 95%CI, 66%to 90%) who had intraperitoneal fluid found on an abdominal CT scan, and 9 patients (0.97%; 95%CI, 0.44%to 1.8%) underwent laparotomy. The proportion of patients with abdominal CT scans was 241 of 460 (52.4%) in the FAST group and 254 of 465 (54.6%) in the standard care-only group (difference, -2.2%; 95%CI, -8.7%to 4.2%). One case of missed intra-abdominal injury occurred in a patient in the FAST group and none in the control group (difference, 0.2%; 95%CI, -0.6%to 1.2%). The mean ED length of stay was 6.03 hours in the FAST group and 6.07 hours in the standard care-only group (difference, -0.04 hours; 95%CI, -0.47 to 0.40 hours). Median hospital charges were $46 415 in the FAST group and $47 759 in the standard care-only group (difference, -$1180; 95%CI, -$6651 to $4291). CONCLUSIONS AND RELEVANCE Among hemodynamically stable children treated in an ED following blunt torso trauma, the use of FAST compared with standard care only did not improve clinical care, including use of resources; ED length of stay; missed intra-abdominal injuries; or hospital charges. These findings do not support the routine use of FAST in this setting.

AB - IMPORTANCE The utility of the focused assessment with sonography for trauma (FAST) examination in children is unknown. OBJECTIVE To determine if the FAST examination during initial evaluation of injured children improves clinical care. DESIGN, SETTING, AND PARTICIPANTS A randomized clinical trial (April 2012-May 2015) that involved 975 hemodynamically stable children and adolescents younger than 18 years treated for blunt torso trauma at the University of California, Davis Medical Center, a level I trauma center. INTERVENTIONS Patients were randomly assigned to a standard trauma evaluation with the FAST examination by the treating ED physician or a standard trauma evaluation alone. MAIN OUTCOMES AND MEASURES Coprimary outcomeswere rate of abdominal computed tomographic (CT) scans in the ED, missed intra-abdominal injuries, ED length of stay, and hospital charges. RESULTS Among the 925 patients who were randomized (mean [SD] age, 9.7 [5.3] years; 575 males [62%]), all completed the study. A total of 50 patients (5.4%, 95%CI, 4.0% to 7.1%) were diagnosed with intra-abdominal injuries, including 40 (80%; 95%CI, 66%to 90%) who had intraperitoneal fluid found on an abdominal CT scan, and 9 patients (0.97%; 95%CI, 0.44%to 1.8%) underwent laparotomy. The proportion of patients with abdominal CT scans was 241 of 460 (52.4%) in the FAST group and 254 of 465 (54.6%) in the standard care-only group (difference, -2.2%; 95%CI, -8.7%to 4.2%). One case of missed intra-abdominal injury occurred in a patient in the FAST group and none in the control group (difference, 0.2%; 95%CI, -0.6%to 1.2%). The mean ED length of stay was 6.03 hours in the FAST group and 6.07 hours in the standard care-only group (difference, -0.04 hours; 95%CI, -0.47 to 0.40 hours). Median hospital charges were $46 415 in the FAST group and $47 759 in the standard care-only group (difference, -$1180; 95%CI, -$6651 to $4291). CONCLUSIONS AND RELEVANCE Among hemodynamically stable children treated in an ED following blunt torso trauma, the use of FAST compared with standard care only did not improve clinical care, including use of resources; ED length of stay; missed intra-abdominal injuries; or hospital charges. These findings do not support the routine use of FAST in this setting.

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U2 - 10.1001/jama.2017.6322

DO - 10.1001/jama.2017.6322

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JO - JAMA - Journal of the American Medical Association

JF - JAMA - Journal of the American Medical Association

SN - 0002-9955

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