Use of the focused assessment with sonography for trauma (FAST) examination and its impact on abdominal computed tomography use in hemodynamically stable children with blunt torso trauma

Jay Menaker, Stephen Blumberg, David H Wisner, Peter S. Dayan, Michael Tunik, Madelyn Garcia, Prashant Mahajan, Kent Page, David Monroe, Dominic Borgialli, Nathan Kuppermann, James F Holmes Jr

Research output: Contribution to journalArticle

33 Citations (Scopus)

Abstract

BACKGROUND: The aim of this study was to evaluate the variability of clinician-performed Focused Assessment with Sonography for Trauma (FAST) examinations and its impact on abdominal computed tomography (AbCT) use in hemodynamically stable children with blunt torso trauma (BTT). The FAST is used with variable frequency in children with BTT. METHODS: We performed a planned secondary analysis of children (<18 years) with BTT. Patients with a Glasgow Coma Scale (GCS) score of less than 9, those with hypotension, and those taken directly to the operating suite were excluded. Clinicians documented their suspicion for intra-abdominal injury (IAI) as very low, less than 1%; low, 1% to 5%; moderate, 6% to 10%; high, 11% to 50%; or very high, greater than 50%. We determined the relative risk (RR) for AbCT use based on undergoing a FAST examination in each of these clinical suspicion strata. RESULTS: Of 6,468 (median age, 11.8 years; interquartile range, 6.3-15.5 years) children who met eligibility, 887 (13.7%) underwent FAST examination before CT scan. A total of 3,015 (46.6%) underwent AbCT scanning, and 373 (5.8%) were diagnosed with IAI. Use of the FAST increased as clinician suspicion for IAI increased, 11.0% with less than 1% suspicion for IAI, 13.5% with 1% to 5% suspicion, 20.5% with 6% to 10% suspicion, 23.2% with 11% to 50% suspicion, and 30.7% with greater than 50% suspicion. The patients in whom the clinicians had a suspicion of IAI of 1% to 5% or 6% to 10% were significantly less likely to undergo a CT scan if a FAST examination was performed: RR, 0.83 (0.67-1.03); RR, 0.81 (0.72-0.91); RR, 0.85 (0.78-0.94); RR, 0.99 (0.94-1.05); and RR, 0.97 (0.91-1.05) for patients with clinician suspicion of IAI of less than 1%, 1% to 5%, 6% to 10%, 11% to 50%, and greater than 50%, respectively. CONCLUSION: The FAST examination is used in a relatively small percentage of children with BTT. Use increases as clinician suspicion for IAI increases. Patients with a low or moderate clinician suspicion of IAI are less likely to undergo AbCT if they receive a FAST examination. A randomized controlled trial is required to more precisely determine the benefits and drawbacks of the FAST examination in the evaluation of children with BTT. LEVEL OF EVIDENCE: Prognostic and epidemiologic study, II.

Original languageEnglish (US)
Pages (from-to)427-432
Number of pages6
JournalJournal of Trauma and Acute Care Surgery
Volume77
Issue number3
DOIs
StatePublished - 2014

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Torso
Ultrasonography
Tomography
Abdominal Injuries
Wounds and Injuries
Glasgow Coma Scale
Hypotension

Keywords

  • children
  • FAST examination
  • Intra-abdominal injury
  • pediatric trauma
  • ultrasonography

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine
  • Surgery

Cite this

Use of the focused assessment with sonography for trauma (FAST) examination and its impact on abdominal computed tomography use in hemodynamically stable children with blunt torso trauma. / Menaker, Jay; Blumberg, Stephen; Wisner, David H; Dayan, Peter S.; Tunik, Michael; Garcia, Madelyn; Mahajan, Prashant; Page, Kent; Monroe, David; Borgialli, Dominic; Kuppermann, Nathan; Holmes Jr, James F.

In: Journal of Trauma and Acute Care Surgery, Vol. 77, No. 3, 2014, p. 427-432.

Research output: Contribution to journalArticle

Menaker, Jay ; Blumberg, Stephen ; Wisner, David H ; Dayan, Peter S. ; Tunik, Michael ; Garcia, Madelyn ; Mahajan, Prashant ; Page, Kent ; Monroe, David ; Borgialli, Dominic ; Kuppermann, Nathan ; Holmes Jr, James F. / Use of the focused assessment with sonography for trauma (FAST) examination and its impact on abdominal computed tomography use in hemodynamically stable children with blunt torso trauma. In: Journal of Trauma and Acute Care Surgery. 2014 ; Vol. 77, No. 3. pp. 427-432.
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title = "Use of the focused assessment with sonography for trauma (FAST) examination and its impact on abdominal computed tomography use in hemodynamically stable children with blunt torso trauma",
abstract = "BACKGROUND: The aim of this study was to evaluate the variability of clinician-performed Focused Assessment with Sonography for Trauma (FAST) examinations and its impact on abdominal computed tomography (AbCT) use in hemodynamically stable children with blunt torso trauma (BTT). The FAST is used with variable frequency in children with BTT. METHODS: We performed a planned secondary analysis of children (<18 years) with BTT. Patients with a Glasgow Coma Scale (GCS) score of less than 9, those with hypotension, and those taken directly to the operating suite were excluded. Clinicians documented their suspicion for intra-abdominal injury (IAI) as very low, less than 1{\%}; low, 1{\%} to 5{\%}; moderate, 6{\%} to 10{\%}; high, 11{\%} to 50{\%}; or very high, greater than 50{\%}. We determined the relative risk (RR) for AbCT use based on undergoing a FAST examination in each of these clinical suspicion strata. RESULTS: Of 6,468 (median age, 11.8 years; interquartile range, 6.3-15.5 years) children who met eligibility, 887 (13.7{\%}) underwent FAST examination before CT scan. A total of 3,015 (46.6{\%}) underwent AbCT scanning, and 373 (5.8{\%}) were diagnosed with IAI. Use of the FAST increased as clinician suspicion for IAI increased, 11.0{\%} with less than 1{\%} suspicion for IAI, 13.5{\%} with 1{\%} to 5{\%} suspicion, 20.5{\%} with 6{\%} to 10{\%} suspicion, 23.2{\%} with 11{\%} to 50{\%} suspicion, and 30.7{\%} with greater than 50{\%} suspicion. The patients in whom the clinicians had a suspicion of IAI of 1{\%} to 5{\%} or 6{\%} to 10{\%} were significantly less likely to undergo a CT scan if a FAST examination was performed: RR, 0.83 (0.67-1.03); RR, 0.81 (0.72-0.91); RR, 0.85 (0.78-0.94); RR, 0.99 (0.94-1.05); and RR, 0.97 (0.91-1.05) for patients with clinician suspicion of IAI of less than 1{\%}, 1{\%} to 5{\%}, 6{\%} to 10{\%}, 11{\%} to 50{\%}, and greater than 50{\%}, respectively. CONCLUSION: The FAST examination is used in a relatively small percentage of children with BTT. Use increases as clinician suspicion for IAI increases. Patients with a low or moderate clinician suspicion of IAI are less likely to undergo AbCT if they receive a FAST examination. A randomized controlled trial is required to more precisely determine the benefits and drawbacks of the FAST examination in the evaluation of children with BTT. LEVEL OF EVIDENCE: Prognostic and epidemiologic study, II.",
keywords = "children, FAST examination, Intra-abdominal injury, pediatric trauma, ultrasonography",
author = "Jay Menaker and Stephen Blumberg and Wisner, {David H} and Dayan, {Peter S.} and Michael Tunik and Madelyn Garcia and Prashant Mahajan and Kent Page and David Monroe and Dominic Borgialli and Nathan Kuppermann and {Holmes Jr}, {James F}",
year = "2014",
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language = "English (US)",
volume = "77",
pages = "427--432",
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TY - JOUR

T1 - Use of the focused assessment with sonography for trauma (FAST) examination and its impact on abdominal computed tomography use in hemodynamically stable children with blunt torso trauma

AU - Menaker, Jay

AU - Blumberg, Stephen

AU - Wisner, David H

AU - Dayan, Peter S.

AU - Tunik, Michael

AU - Garcia, Madelyn

AU - Mahajan, Prashant

AU - Page, Kent

AU - Monroe, David

AU - Borgialli, Dominic

AU - Kuppermann, Nathan

AU - Holmes Jr, James F

PY - 2014

Y1 - 2014

N2 - BACKGROUND: The aim of this study was to evaluate the variability of clinician-performed Focused Assessment with Sonography for Trauma (FAST) examinations and its impact on abdominal computed tomography (AbCT) use in hemodynamically stable children with blunt torso trauma (BTT). The FAST is used with variable frequency in children with BTT. METHODS: We performed a planned secondary analysis of children (<18 years) with BTT. Patients with a Glasgow Coma Scale (GCS) score of less than 9, those with hypotension, and those taken directly to the operating suite were excluded. Clinicians documented their suspicion for intra-abdominal injury (IAI) as very low, less than 1%; low, 1% to 5%; moderate, 6% to 10%; high, 11% to 50%; or very high, greater than 50%. We determined the relative risk (RR) for AbCT use based on undergoing a FAST examination in each of these clinical suspicion strata. RESULTS: Of 6,468 (median age, 11.8 years; interquartile range, 6.3-15.5 years) children who met eligibility, 887 (13.7%) underwent FAST examination before CT scan. A total of 3,015 (46.6%) underwent AbCT scanning, and 373 (5.8%) were diagnosed with IAI. Use of the FAST increased as clinician suspicion for IAI increased, 11.0% with less than 1% suspicion for IAI, 13.5% with 1% to 5% suspicion, 20.5% with 6% to 10% suspicion, 23.2% with 11% to 50% suspicion, and 30.7% with greater than 50% suspicion. The patients in whom the clinicians had a suspicion of IAI of 1% to 5% or 6% to 10% were significantly less likely to undergo a CT scan if a FAST examination was performed: RR, 0.83 (0.67-1.03); RR, 0.81 (0.72-0.91); RR, 0.85 (0.78-0.94); RR, 0.99 (0.94-1.05); and RR, 0.97 (0.91-1.05) for patients with clinician suspicion of IAI of less than 1%, 1% to 5%, 6% to 10%, 11% to 50%, and greater than 50%, respectively. CONCLUSION: The FAST examination is used in a relatively small percentage of children with BTT. Use increases as clinician suspicion for IAI increases. Patients with a low or moderate clinician suspicion of IAI are less likely to undergo AbCT if they receive a FAST examination. A randomized controlled trial is required to more precisely determine the benefits and drawbacks of the FAST examination in the evaluation of children with BTT. LEVEL OF EVIDENCE: Prognostic and epidemiologic study, II.

AB - BACKGROUND: The aim of this study was to evaluate the variability of clinician-performed Focused Assessment with Sonography for Trauma (FAST) examinations and its impact on abdominal computed tomography (AbCT) use in hemodynamically stable children with blunt torso trauma (BTT). The FAST is used with variable frequency in children with BTT. METHODS: We performed a planned secondary analysis of children (<18 years) with BTT. Patients with a Glasgow Coma Scale (GCS) score of less than 9, those with hypotension, and those taken directly to the operating suite were excluded. Clinicians documented their suspicion for intra-abdominal injury (IAI) as very low, less than 1%; low, 1% to 5%; moderate, 6% to 10%; high, 11% to 50%; or very high, greater than 50%. We determined the relative risk (RR) for AbCT use based on undergoing a FAST examination in each of these clinical suspicion strata. RESULTS: Of 6,468 (median age, 11.8 years; interquartile range, 6.3-15.5 years) children who met eligibility, 887 (13.7%) underwent FAST examination before CT scan. A total of 3,015 (46.6%) underwent AbCT scanning, and 373 (5.8%) were diagnosed with IAI. Use of the FAST increased as clinician suspicion for IAI increased, 11.0% with less than 1% suspicion for IAI, 13.5% with 1% to 5% suspicion, 20.5% with 6% to 10% suspicion, 23.2% with 11% to 50% suspicion, and 30.7% with greater than 50% suspicion. The patients in whom the clinicians had a suspicion of IAI of 1% to 5% or 6% to 10% were significantly less likely to undergo a CT scan if a FAST examination was performed: RR, 0.83 (0.67-1.03); RR, 0.81 (0.72-0.91); RR, 0.85 (0.78-0.94); RR, 0.99 (0.94-1.05); and RR, 0.97 (0.91-1.05) for patients with clinician suspicion of IAI of less than 1%, 1% to 5%, 6% to 10%, 11% to 50%, and greater than 50%, respectively. CONCLUSION: The FAST examination is used in a relatively small percentage of children with BTT. Use increases as clinician suspicion for IAI increases. Patients with a low or moderate clinician suspicion of IAI are less likely to undergo AbCT if they receive a FAST examination. A randomized controlled trial is required to more precisely determine the benefits and drawbacks of the FAST examination in the evaluation of children with BTT. LEVEL OF EVIDENCE: Prognostic and epidemiologic study, II.

KW - children

KW - FAST examination

KW - Intra-abdominal injury

KW - pediatric trauma

KW - ultrasonography

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