Sensitivity and specificity of FAST scanning in paediatric patients following blunt abdominal trauma
Date First Published:
February 7, 2008
Last Updated:
June 10, 2011
Report by:
Ben Hall, StR Emergency Medicine (AMD / Birmingham Children's Hospital)
Three-Part Question:
In [paediatric patients with blunt abdominal trauma] how sensitive and specific is [FAST (Focussed Assessment with Sonography in Trauma) scanning] for [diagnosing intra-abdominal free fluid]?
Clinical Scenario:
A 8 year old boy present to your Emergency Department having sustained blunt abdominal trauma in a road traffic collision. You are familiar with the use of FAST in adult patients in similar situations, and wonder whether the investigation is useful in the paediatric patient.
Search Strategy:
Ovid MEDLINE(R) In-Process & Other Non-Indexed Citations and Ovid MEDLINE(R) <1948 to Present>
Search Details:
focussed OR focused AND abdominal AND ultrasound OR sonography OR Ultrasonography OR ultrasonography AND trauma OR "Wounds and Injuries" AND "Pediatrics" OR "Child"
Outcome:
27 papers were found of which 20 did not consider children specifically or were otherwise irrelevant.
Relevant Paper(s):
| Study Title | Patient Group | Study type (level of evidence) | Outcomes | Key results | Study Weaknesses |
|---|---|---|---|---|---|
| Pediatric FAST and elevated liver transaminases: An effective screening tool in blunt abdominal trauma. Sola JE et al 2009 USA | 3171 patients aged under 16 with blunt abdominal trauma, of whom 497 underwent both FAST and CT scan | Diagnostic cohort, retrospective | Sensitivity | 50% | Not all patients in the study who underwent FAST also had CT. |
| Specificity | 91% | ||||
| Diagnostic accuracy of surgeon-performed focused abdominal sonography (FAST) in blunt pediatric trauma. Soundappan SV et al. 2005 Australia | 85 patients aged from 4 months to 16 years who sustained blunt abdominal trauma and underwent FAST scan and CT | Prospective, single-blinded study | Sensitivity | 81% | Only 19 of 76 patients with negative FAST underwent CT scan. |
| Specificity | 100% | ||||
| Experience with focused abdominal sonography for trauma (FAST) in 313 pediatric patients. Soudack M et al 2004 Israel | 313 paediatric patients who had sustained multiple traumatic injuries | Retrospective | Sensitivity | 92.50% | Many patients did not undergo any further investigation after negative FAST (assumed to be clear based on conservative management without complications) |
| Specificity | 97.20% | ||||
| Focused abdominal sonography for trauma (FAST) in children with blunt abdominal trauma. Coley BD et al. 2000 USA | 107 haemodynamically stable children undergoing CT for blunt abdominal trauma, prospectively investigated using FAST | Prospective diagnostic cohort | Sensitivity | 55% | Small numbers; also relatively early study - possibly not valid for comparison with current equipment and technique. |
| Preliminary experience with focused abdominal sonography for trauma (FAST) in children: Is it useful? Mutabagani KH et al. 1999 USA | 46 haemodynamically stable children undergoing investigation for suspected intraabdominal injury | Prospective diagnostic cohort | Sensitivity | 30% | Small numbers; also relatively early study - possibly not valid for comparison with current equipment and technique. |
| Specificity | 100% | ||||
| The efficacy of focused abdominal sonography for trauma (FAST) as a screening tool in the assessment of injured children. Patel JC & Tepas JJ 1999 USA | 94 children who had undergone FAST reviewed with respect to their subsequent management requirements. | Retrospective diagnostic cohort. | Sensitivity | 33% | Most children did not undergo CT - "gold standard" for purposes of comparison was need for surgery. Also relatively early study - possibly not valid for comparison with current equipment and technique. |
| Specificity | 95% | ||||
| Validation of surgeon-performed emergency abdominal ultrasonography in pediatric trauma patients. Thourani VH et al. 1998 USA | 192 pediatric trauma patients (98% blunt injury) | Prospective diagnostic cohort | Small numbers; also relatively early study - possibly not valid for comparison with current equipment and technique. |
Author Commentary:
Current research shows that FAST in this context has a high specificty. Sensitivity is much lower, but the data are highly varied. Further high-quality research using modern equipment and technique is required.
Bottom Line:
FAST scan in children with blunt abdominal trauma is highly specific and can be used to rule-in free fluid without the need for exposure to radiation-based imaging.
References:
- Sola JE et al. Pediatric FAST and elevated liver transaminases: An effective screening tool in blunt abdominal trauma.
- Soundappan SV et al.. Diagnostic accuracy of surgeon-performed focused abdominal sonography (FAST) in blunt pediatric trauma.
- Soudack M et al. Experience with focused abdominal sonography for trauma (FAST) in 313 pediatric patients.
- Coley BD et al.. Focused abdominal sonography for trauma (FAST) in children with blunt abdominal trauma.
- Mutabagani KH et al.. Preliminary experience with focused abdominal sonography for trauma (FAST) in children: Is it useful?
- Patel JC & Tepas JJ. The efficacy of focused abdominal sonography for trauma (FAST) as a screening tool in the assessment of injured children.
- Thourani VH et al.. Validation of surgeon-performed emergency abdominal ultrasonography in pediatric trauma patients.