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FAST exam not suitable in EDs for children with blunt torso trauma

Using focused assessment with sonography for trauma, or FAST, did not improve clinical care compared with standard care only among children treated in the ED following blunt torso trauma, according to data published in JAMA.

“Evidence from randomized clinical trials involving adults indicates that incorporating the FAST examination during the initial evaluation resulted in decreased abdominal CT use, hospital lengths of stay, complications, and hospital charges,” James F. Holmes, MD, MPH, from the department of emergency medicine at the University of California Davis School of Medicine, Sacramento, and colleagues wrote. “The FAST examination is not routinely used in the initial evaluation of injured children, perhaps reflecting the absence of randomized clinical trials involving children.”

Researchers assessed whether performing the FAST exam during the initial evaluation of children presenting to the ED with blunt torso trauma improved clinical care. They randomly assigned 925 pediatric patients to receive either a standard trauma evaluation with the FAST examination or a standard trauma evaluation alone, then compared the rate of abdominal CT scans in the ED, missed intra-abdominal injuries, length of stay and hospital charges.

Fifty patients with blunt torso trauma were diagnosed with intra-abdominal injuries (95% CI, 4-7.1). Of these patients, 40 had intraperitoneal fluid found on an abdominal CT scan (80%; 95% CI, 66-90) and nine underwent laparotomy (0.97%; 95% CI, 0.44-1.8). In the FAST group, 240 of 460 patients (52.6%) received abdominal CT scans compared with 254 of 465 patents (54.6%) in the standard care only group (–2.2%; 95% CI, –8.7 to 4.2). Additionally, a case of missed intra-abdominal injury only occurred in the FAST group. When comparing the mean ED length of stay, the FAST group was only 0.04 hours shorter than the standard care-only group (6.03 hours vs. 6.07 hours). The median hospital charges in the FAST group were $1,180 less than the mean charges in the other group ($46,415 vs. $47,759).

“The use of the FAST examination compared with standard care only did not improve any of the primary outcomes including resource use, ED [length of stay], missed intra-abdominal injuries, or hospital charges,” Holmes and colleagues wrote. “Therefore, the study suggests that the routine use of the FAST examination in hemodynamically stable children with blunt torso trauma may not be useful.”

In a related editorial, David O. Kessler, MD, MSc, from Colombia University College of Physicians and Surgeons, wrote that these findings should encourage further research into the integration of FAST examination in pediatric blunt torso trauma protocols.

“Quality improvement or implementation studies may be better suited to studying the desired behavior changes resulting from FAST algorithms,” Kessler wrote. “This is worth pursuing considering the potential to reduce exposure to ionizing radiation, the evolving technological advances, and the minimal risks associated with point-of-care ultrasound.” – by Savannah Demko

Disclosures: Holmes reports no relevant financial disclosures. Kessler reports no relevant financial disclosures.