Development of a Consensus-Based Definition of Focused Assessment With Sonography for Trauma in Children

Abstract

IMPORTANCEThe wide variation in the accuracy and reliability of the Focused Assessment With Sonography for Trauma (FAST) and the extended FAST (E-FAST) for children after blunt abdominal trauma reflects user expertise. FAST and E-FAST that are performed by experts tend to be more complete, better quality, and more often clinically valuable. OBJECTIVETo develop definitions of a complete, high-quality, and accurate interpretation for the FAST and E-FAST in children with injury using an expert, consensus-based modified Delphi technique. DESIGN, SETTING, AND PARTICIPANTS This consensus-based qualitative study was conducted between May 1 to June 30, 2021. It used a scoping review and iterative Delphi technique and involved 2 rounds of online surveys and a live webinar to achieve consensus among a 26-member panel. This panel consisted of international experts in pediatric emergency point-of-care ultrasonography. MAIN OUTCOMES AND MEASURES Definitions of complete, high-quality, and accurate FAST and E-FAST studies for children after injury. RESULTSOf the 29 invited pediatric FAST experts, 26 (15 men [58%]) agreed to participate in the panel. All 26 panelists completed the 2 rounds of surveys, and 24 (92%) participated in the live and asynchronous online discussions. Consensus was reached on FAST and E-FAST study definitions, and the panelists rated these 5 anatomic views as important and appropriate for a complete FAST: right upper-quadrant abdominal view, left upper-quadrant abdominal view, suprapubic views (transverse and sagittal), and subxiphoid cardiac view. For E-FAST, the same FAST anatomic views with the addition of the lung or pneumothorax view were deemed appropriate and important. In addition, the panelists rated a total of 32 landmarks as important for assessing completeness. Similarly, the panelists rated 14 statements on quality and 20 statements on accurate interpretation as appropriate.CONCLUSIONS AND RELEVANCE This qualitative study generated definitions for complete FAST and E-FAST studies with high image quality and accurate interpretation in children with injury. These definitions are similar to those in adults with injury and may be used for future education, quality assurance, and research. Future research may focus on interpretation of trace volumes of abdominal free fluid and the use of serial FAST.

Focused Evaluation With Ultrasound in Thoracoabdominal Trauma

“…FAST is called a focused evaluation protocol with ultrasound for trauma, the same one that evaluates the main body cavities, through different windows of ultrasound vision (Kornblith et al, 2022).…”

“…The Trendelenburg position could facilitate the visualization of the liquid collection in the Morrison space, which is evidenced by an anechoic image (Kornblith et al, 2022).…”

Establishing the international research priorities for pediatric emergency medicine point‐of‐care ultrasound: A modified Delphi study

“…One of its objectives was to provide a platform for PEM POCUS experts worldwide to collaborate on multicenter research, with the goal of informing clinical practice. To date, the P2Network's research priorities have stemmed from the research interests of individual members 13,14 …”

“…To date, the P2Network's research priorities have stemmed from the research interests of individual members. 13,14 Given the continued growth of POCUS within PEM and recognition of the need for high-quality evidence, there is a need to develop an agenda to guide global research priorities. Establishing a research agenda helps to streamline prioritization and planning of studies, guide allocation of resources, and avoid potential duplication of efforts.…”

“…To date, the P2Network's research priorities have stemmed from the research interests of individual members. 13 , 14 …”