Focused Assessment with Sonography in Trauma (FAST) Scans Are Not Sufficiently Sensitive to Rule out Significant Injury in Pediatric Trauma Patients

Abstract

Aim: To assess the sensitivity and specificity of FAST scans in pediatric trauma in a dedicated pediatric trauma centre. Method: A 3-year (2008-2011) analysis of prospectively collected data looking at the results of FAST scans compared to Computed Tomography (CT) or laparotomy findings. Results: There were 482 pediatric trauma calls of which 166 patients had suspected intra-abdominal injury. 163 patients underwent CT scans of which 89 (55%) had FAST scans prior to CT. 3 patients had FAST scans without CT; 1 patient went straight to theatre (positive FAST) and 2 patients died in the department before any further imaging. The sensitivity of FAST scans to detect abdominal injury is 23% and the specificity is 97%. The injuries missed on FAST scan were: liver lacerations (n = 3), splenic lacerations (n = 5), 1 combined liver and kidney injury and 1 combined splenic injury and small bowel perforation. Conclusions: FAST scans in trauma have a low sensitivity in pediatric patients with the possibility of missing significant intra-abdominal injury. They do not obviate the need for CT scan when clinical suspicion is high.

Pediatric adrenal trauma: evaluation and follow-up with contrast-enhanced ultrasound (CEUS)

“…A focal assessment with sonography for trauma (FAST scan) examination in the emergency department often represents the first-line modality in trauma to evaluate for the presence of free intraabdominal fluid. A FAST scan is able to detect C250 ml of fluid but is inconsistent with solid organ injuries [2]; a FAST scan without the presence of free fluid in the abdomen may falsely reassure the physician to solid organ injury integrity [6,21] and is no longer recommended as an appropriate imaging modality in pediatric abdominal trauma. A CECT examination is the ideal modality to evaluate multi-organ trauma patients, both adults and children, and is able to delineate adrenal gland injuries, with the typical findings of rounded hematomas causing enlargement or displacement of the adrenal gland, or features of hemorrhage [2].…”