Focused assessment with sonography for trauma in children after blunt abdominal trauma

A multi-institutional analysis

Bennett W. Calder, Adam M. Vogel, Jingwen Zhang, Patrick D. Mauldin, Eunice Huang, Kate B. Savoie, Matthew T. Santore, Kuo Jen Tsao, Tiffany G. Ostovar-Kermani, Richard A. Falcone, M. Sidney Dassinger, John Recicar, Jeffrey H. Haynes, Martin L. Blakely, Robert T. Russell, Bindi J. Naik-Mathuria, Shawn D. St Peter, David P. Mooney, Chinwendu Onwubiko, Jeffrey S. Upperman & 2 others Jessica A. Zagory, Christian J. Streck

Research output: Contribution to journalArticle

9 Citations (Scopus)

Abstract

Introduction The utility of focused assessment with sonography for trauma (FAST) in children is poorly defined with considerable practice variation. Our purpose was to investigate the role of FAST for intra-abdominal injury (IAI) and IAI requiring acute intervention (IAI-I) in children after blunt abdominal trauma (BAT). Methods We prospectively enrolled children younger than 16 years after BAT at 14 Level I pediatric trauma centers over a 1-year period. Patients who underwent FAST were compared with those that did not, using descriptive statistics and univariate analysis; p value less than 0.05 was considered significant. FAST test characteristics were performed using computed tomography (CT) and/or intraoperative findings as the gold standard. Results Two thousand one hundred eighty-eight children (age, 7.8 ± 4.6 years) were included. Eight hundred twenty-nine (37.9%) received a FAST, 340 of whom underwent an abdominal CT. Ninety-seven (29%) of these 340 patients had an IAI and 27 (7.9%) received an acute intervention. CT scan utilization after FAST was 41% versus 46% among those who did not receive FAST. The frequency of FAST among centers ranged from 0.84% to 94.1%. There was low correlation between FAST and CT utilization (r = -0.050, p < 0.001). Centers that performed FAST at a higher frequency did not have improved accuracy. The test performance of FAST for IAI was sensitivity, 27.8%; specificity, 91.4%; positive predictive value, 56.2%; negative predictive value, 76.0%; and accuracy, 73.2%. There were 81 injuries among the 70 false-negative FAST. The test performance of FAST for IAI-I was sensitivity, 44.4%; specificity, 88.5%; positive predictive value, 25.0%; negative predictive value, 94.9%; and accuracy, 85.0%. Fifteen children with a negative FAST received acute interventions. Among the 27 patients with true positive FAST examinations, 12 received intervention. All had an abnormal abdominal physical examination. No patient underwent intervention before CT scan. Conclusion As currently used, FAST has a low sensitivity for IAI, misses IAI-I and rarely impacts management in pediatric BAT. Level Of Evidence: Prognostic and epidemiologic study, level II; diagnostic tests or criteria study, level II; therapeutic/care management study, level III.

Original languageEnglish (US)
Pages (from-to)218-224
Number of pages7
JournalJournal of Trauma and Acute Care Surgery
Volume83
Issue number2
DOIs
StatePublished - Aug 1 2017

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Ultrasonography
Wounds and Injuries
Abdominal Injuries
Tomography
Trauma Centers
Pediatrics
Routine Diagnostic Tests
Physical Examination
Epidemiologic Studies

All Science Journal Classification (ASJC) codes

  • Surgery
  • Critical Care and Intensive Care Medicine

Cite this

Focused assessment with sonography for trauma in children after blunt abdominal trauma : A multi-institutional analysis. / Calder, Bennett W.; Vogel, Adam M.; Zhang, Jingwen; Mauldin, Patrick D.; Huang, Eunice; Savoie, Kate B.; Santore, Matthew T.; Tsao, Kuo Jen; Ostovar-Kermani, Tiffany G.; Falcone, Richard A.; Dassinger, M. Sidney; Recicar, John; Haynes, Jeffrey H.; Blakely, Martin L.; Russell, Robert T.; Naik-Mathuria, Bindi J.; St Peter, Shawn D.; Mooney, David P.; Onwubiko, Chinwendu; Upperman, Jeffrey S.; Zagory, Jessica A.; Streck, Christian J.

In: Journal of Trauma and Acute Care Surgery, Vol. 83, No. 2, 01.08.2017, p. 218-224.

Research output: Contribution to journalArticle

Calder, BW, Vogel, AM, Zhang, J, Mauldin, PD, Huang, E, Savoie, KB, Santore, MT, Tsao, KJ, Ostovar-Kermani, TG, Falcone, RA, Dassinger, MS, Recicar, J, Haynes, JH, Blakely, ML, Russell, RT, Naik-Mathuria, BJ, St Peter, SD, Mooney, DP, Onwubiko, C, Upperman, JS, Zagory, JA & Streck, CJ 2017, 'Focused assessment with sonography for trauma in children after blunt abdominal trauma: A multi-institutional analysis', Journal of Trauma and Acute Care Surgery, vol. 83, no. 2, pp. 218-224. https://doi.org/10.1097/TA.0000000000001546
Calder, Bennett W. ; Vogel, Adam M. ; Zhang, Jingwen ; Mauldin, Patrick D. ; Huang, Eunice ; Savoie, Kate B. ; Santore, Matthew T. ; Tsao, Kuo Jen ; Ostovar-Kermani, Tiffany G. ; Falcone, Richard A. ; Dassinger, M. Sidney ; Recicar, John ; Haynes, Jeffrey H. ; Blakely, Martin L. ; Russell, Robert T. ; Naik-Mathuria, Bindi J. ; St Peter, Shawn D. ; Mooney, David P. ; Onwubiko, Chinwendu ; Upperman, Jeffrey S. ; Zagory, Jessica A. ; Streck, Christian J. / Focused assessment with sonography for trauma in children after blunt abdominal trauma : A multi-institutional analysis. In: Journal of Trauma and Acute Care Surgery. 2017 ; Vol. 83, No. 2. pp. 218-224.
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abstract = "Introduction The utility of focused assessment with sonography for trauma (FAST) in children is poorly defined with considerable practice variation. Our purpose was to investigate the role of FAST for intra-abdominal injury (IAI) and IAI requiring acute intervention (IAI-I) in children after blunt abdominal trauma (BAT). Methods We prospectively enrolled children younger than 16 years after BAT at 14 Level I pediatric trauma centers over a 1-year period. Patients who underwent FAST were compared with those that did not, using descriptive statistics and univariate analysis; p value less than 0.05 was considered significant. FAST test characteristics were performed using computed tomography (CT) and/or intraoperative findings as the gold standard. Results Two thousand one hundred eighty-eight children (age, 7.8 ± 4.6 years) were included. Eight hundred twenty-nine (37.9{\%}) received a FAST, 340 of whom underwent an abdominal CT. Ninety-seven (29{\%}) of these 340 patients had an IAI and 27 (7.9{\%}) received an acute intervention. CT scan utilization after FAST was 41{\%} versus 46{\%} among those who did not receive FAST. The frequency of FAST among centers ranged from 0.84{\%} to 94.1{\%}. There was low correlation between FAST and CT utilization (r = -0.050, p < 0.001). Centers that performed FAST at a higher frequency did not have improved accuracy. The test performance of FAST for IAI was sensitivity, 27.8{\%}; specificity, 91.4{\%}; positive predictive value, 56.2{\%}; negative predictive value, 76.0{\%}; and accuracy, 73.2{\%}. There were 81 injuries among the 70 false-negative FAST. The test performance of FAST for IAI-I was sensitivity, 44.4{\%}; specificity, 88.5{\%}; positive predictive value, 25.0{\%}; negative predictive value, 94.9{\%}; and accuracy, 85.0{\%}. Fifteen children with a negative FAST received acute interventions. Among the 27 patients with true positive FAST examinations, 12 received intervention. All had an abnormal abdominal physical examination. No patient underwent intervention before CT scan. Conclusion As currently used, FAST has a low sensitivity for IAI, misses IAI-I and rarely impacts management in pediatric BAT. Level Of Evidence: Prognostic and epidemiologic study, level II; diagnostic tests or criteria study, level II; therapeutic/care management study, level III.",
author = "Calder, {Bennett W.} and Vogel, {Adam M.} and Jingwen Zhang and Mauldin, {Patrick D.} and Eunice Huang and Savoie, {Kate B.} and Santore, {Matthew T.} and Tsao, {Kuo Jen} and Ostovar-Kermani, {Tiffany G.} and Falcone, {Richard A.} and Dassinger, {M. Sidney} and John Recicar and Haynes, {Jeffrey H.} and Blakely, {Martin L.} and Russell, {Robert T.} and Naik-Mathuria, {Bindi J.} and {St Peter}, {Shawn D.} and Mooney, {David P.} and Chinwendu Onwubiko and Upperman, {Jeffrey S.} and Zagory, {Jessica A.} and Streck, {Christian J.}",
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TY - JOUR

T1 - Focused assessment with sonography for trauma in children after blunt abdominal trauma

T2 - A multi-institutional analysis

AU - Calder, Bennett W.

AU - Vogel, Adam M.

AU - Zhang, Jingwen

AU - Mauldin, Patrick D.

AU - Huang, Eunice

AU - Savoie, Kate B.

AU - Santore, Matthew T.

AU - Tsao, Kuo Jen

AU - Ostovar-Kermani, Tiffany G.

AU - Falcone, Richard A.

AU - Dassinger, M. Sidney

AU - Recicar, John

AU - Haynes, Jeffrey H.

AU - Blakely, Martin L.

AU - Russell, Robert T.

AU - Naik-Mathuria, Bindi J.

AU - St Peter, Shawn D.

AU - Mooney, David P.

AU - Onwubiko, Chinwendu

AU - Upperman, Jeffrey S.

AU - Zagory, Jessica A.

AU - Streck, Christian J.

PY - 2017/8/1

Y1 - 2017/8/1

N2 - Introduction The utility of focused assessment with sonography for trauma (FAST) in children is poorly defined with considerable practice variation. Our purpose was to investigate the role of FAST for intra-abdominal injury (IAI) and IAI requiring acute intervention (IAI-I) in children after blunt abdominal trauma (BAT). Methods We prospectively enrolled children younger than 16 years after BAT at 14 Level I pediatric trauma centers over a 1-year period. Patients who underwent FAST were compared with those that did not, using descriptive statistics and univariate analysis; p value less than 0.05 was considered significant. FAST test characteristics were performed using computed tomography (CT) and/or intraoperative findings as the gold standard. Results Two thousand one hundred eighty-eight children (age, 7.8 ± 4.6 years) were included. Eight hundred twenty-nine (37.9%) received a FAST, 340 of whom underwent an abdominal CT. Ninety-seven (29%) of these 340 patients had an IAI and 27 (7.9%) received an acute intervention. CT scan utilization after FAST was 41% versus 46% among those who did not receive FAST. The frequency of FAST among centers ranged from 0.84% to 94.1%. There was low correlation between FAST and CT utilization (r = -0.050, p < 0.001). Centers that performed FAST at a higher frequency did not have improved accuracy. The test performance of FAST for IAI was sensitivity, 27.8%; specificity, 91.4%; positive predictive value, 56.2%; negative predictive value, 76.0%; and accuracy, 73.2%. There were 81 injuries among the 70 false-negative FAST. The test performance of FAST for IAI-I was sensitivity, 44.4%; specificity, 88.5%; positive predictive value, 25.0%; negative predictive value, 94.9%; and accuracy, 85.0%. Fifteen children with a negative FAST received acute interventions. Among the 27 patients with true positive FAST examinations, 12 received intervention. All had an abnormal abdominal physical examination. No patient underwent intervention before CT scan. Conclusion As currently used, FAST has a low sensitivity for IAI, misses IAI-I and rarely impacts management in pediatric BAT. Level Of Evidence: Prognostic and epidemiologic study, level II; diagnostic tests or criteria study, level II; therapeutic/care management study, level III.

AB - Introduction The utility of focused assessment with sonography for trauma (FAST) in children is poorly defined with considerable practice variation. Our purpose was to investigate the role of FAST for intra-abdominal injury (IAI) and IAI requiring acute intervention (IAI-I) in children after blunt abdominal trauma (BAT). Methods We prospectively enrolled children younger than 16 years after BAT at 14 Level I pediatric trauma centers over a 1-year period. Patients who underwent FAST were compared with those that did not, using descriptive statistics and univariate analysis; p value less than 0.05 was considered significant. FAST test characteristics were performed using computed tomography (CT) and/or intraoperative findings as the gold standard. Results Two thousand one hundred eighty-eight children (age, 7.8 ± 4.6 years) were included. Eight hundred twenty-nine (37.9%) received a FAST, 340 of whom underwent an abdominal CT. Ninety-seven (29%) of these 340 patients had an IAI and 27 (7.9%) received an acute intervention. CT scan utilization after FAST was 41% versus 46% among those who did not receive FAST. The frequency of FAST among centers ranged from 0.84% to 94.1%. There was low correlation between FAST and CT utilization (r = -0.050, p < 0.001). Centers that performed FAST at a higher frequency did not have improved accuracy. The test performance of FAST for IAI was sensitivity, 27.8%; specificity, 91.4%; positive predictive value, 56.2%; negative predictive value, 76.0%; and accuracy, 73.2%. There were 81 injuries among the 70 false-negative FAST. The test performance of FAST for IAI-I was sensitivity, 44.4%; specificity, 88.5%; positive predictive value, 25.0%; negative predictive value, 94.9%; and accuracy, 85.0%. Fifteen children with a negative FAST received acute interventions. Among the 27 patients with true positive FAST examinations, 12 received intervention. All had an abnormal abdominal physical examination. No patient underwent intervention before CT scan. Conclusion As currently used, FAST has a low sensitivity for IAI, misses IAI-I and rarely impacts management in pediatric BAT. Level Of Evidence: Prognostic and epidemiologic study, level II; diagnostic tests or criteria study, level II; therapeutic/care management study, level III.

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