Focused assessment with sonography for trauma in predicting early surgical intervention in hemodynamically unstable children with blunt abdominal trauma

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

doi:10.1002/emp2.12650

Focused assessment with sonography for trauma in predicting early surgical intervention in hemodynamically unstable children with blunt abdominal trauma

J Am Coll Emerg Physicians Open. 2022 Jan 27;3(1):e12650. doi: 10.1002/emp2.12650. eCollection 2022 Feb.

Affiliations

¹ Department of Emergency Medicine The University of Texas Health Science Center at Houston McGovern Medical School Houston Texas USA.
² Department of Pediatrics Children's Hospital of Philadelphia Philadelphia Pennsylvania USA.

Abstract

Objectives: The predictive accuracy and clinical role of the focused assessment with sonography for trauma (FAST) exam in pediatric blunt abdominal trauma are uncertain. This study investigates the performance of the emergency department (ED) FAST exam to predict early surgical intervention and subsequent free fluid (FF) in pediatric trauma patients.

Methods: Pediatric level 1 trauma patients ages 0 to 15 years with blunt torso trauma at a single trauma center were retrospectively reviewed. After stratification by initial hemodynamic (HD) instability, the association of a positive FAST with (1) early surgical intervention, defined as operative management (laparotomy or open pericardial window) or angiography within 4 hours of ED arrival and (2) presence of FF during early surgical intervention was determined.

Results: Among 508 salvageable pediatric trauma patients with an interpreted FAST exam, 35 (6.9%) had HD instability and 98 (19.3%) were FAST positive. A total of 42 of 508 (8.3%) patients required early surgical intervention, and the sensitivity and specificity of FAST predicting early surgical intervention were 59.5% and 84.3%, respectively. The specificity and positive predictive value of FF during early surgical intervention in FAST-positive HD unstable patients increased from 50% and 90.9% at 4 hours after ED arrival to 100% and 100% at 2 hours after ED arrival, respectively.

Conclusions: In this large series of injured children, a positive FAST exam improves the ability to predict the need for early surgical intervention, and accuracy is greater for FF in HD unstable patients 2 hours after arrival to the ED.

Keywords: FAST exam; abdominal/gastrointestinal; angiography; blunt injury; focused assessment with sonography for trauma; hypotension; laparotomy; pediatric emergency medicine; pediatric resuscitation; pediatric trauma; pediatrics; pericardiostomy; therapeutic embolization; traumatic brain injury; ultrasound.