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Focused abdominal sonography for trauma in the clinical evaluation of children with blunt abdominal trauma.

Ben-Ishay O, Daoud M, Peled Z, Brauner E, Bahouth H, Kluger Y - World J Emerg Surg (2015)

Bottom Line: CT detected intra-peritoneal fluid in 62/448 (13.8 %) of the patients with negative FAST results.This study shows that although a positive FAST evaluation does not necessarily correlate with an IAI, a negative one strongly suggests the absence of an IAI, with a high NPV.FAST examination tempered with sound clinical judgment seems to be an effective tool to discriminate injured children in need of further imaging evaluation.

View Article: PubMed Central - PubMed

Affiliation: Department of General of Surgery, Division of Surgery Rambam Health Care Campus, 8 Ha'Aliyah St, Haifa, 35254 Israel.

ABSTRACT

Introduction: In pediatric care, the role of focused abdominal sonography in trauma (FAST) remains ill defined. The objective of this study was to assess the sensitivity and specificity of FAST for detecting free peritoneal fluid in children.

Methods: The trauma registry of a single level I pediatric trauma center was queried for the results of FAST examination of consecutive pediatric (<18 years) blunt trauma patients over a period of 36 months, from January 2010 to December 2012. Demographics, type of injuries, FAST results, computerized tomography (CT) results, and operative findings were reviewed.

Results: During the study period, 543 injured pediatric patients (mean age 8.2 ± 5 years) underwent FAST examinations. In 95 (17.5 %) FAST was positive for free peritoneal fluid. CT examination was performed in 219 (40.3 %) children. Positive FAST examination was confirmed by CT scan in 61/73 (83.6 %). CT detected intra-peritoneal fluid in 62/448 (13.8 %) of the patients with negative FAST results. These findings correspond to a sensitivity of 50 %, specificity of 88 %, positive predictive value (PPV) of 84 %, and a negative predictive value (NPV) of 58 %. In patients who had negative FAST results and no CT examination (302), no missed abdominal injury was detected on clinical ground. FAST examination in the young age group (<2 years) yielded lower sensitivity and specificity (36 and 78 % respectively) with a PPV of only 50 %.

Conclusions: This study shows that although a positive FAST evaluation does not necessarily correlate with an IAI, a negative one strongly suggests the absence of an IAI, with a high NPV. These findings are emphasized in the analysis of the subgroup of children less than 2 years of age. FAST examination tempered with sound clinical judgment seems to be an effective tool to discriminate injured children in need of further imaging evaluation.

No MeSH data available.


Related in: MedlinePlus

The detection of intra-abdominal injuries in children, according to FAST and CT results
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Fig2: The detection of intra-abdominal injuries in children, according to FAST and CT results

Mentions: Intra abdominal injury (IAI) was detected in 12 of the 73 patients who had positive FAST results and underwent CT (Fig. 2). None of the patients with a positive FAST result who did not undergo CT had a clinically significant missed IAI, based on clinical findings and follow-up of these patients. The 5 who had an IAI were operated based on the positivity of the FAST examination and their hemodynamic status. Thus, the detection by FAST of IAI yielded a sensitivity of 77 %, specificity of 70 %, and a negative predictive value (NPV) of 97 % (Table 1).Fig. 2


Focused abdominal sonography for trauma in the clinical evaluation of children with blunt abdominal trauma.

Ben-Ishay O, Daoud M, Peled Z, Brauner E, Bahouth H, Kluger Y - World J Emerg Surg (2015)

The detection of intra-abdominal injuries in children, according to FAST and CT results
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4494156&req=5

Fig2: The detection of intra-abdominal injuries in children, according to FAST and CT results
Mentions: Intra abdominal injury (IAI) was detected in 12 of the 73 patients who had positive FAST results and underwent CT (Fig. 2). None of the patients with a positive FAST result who did not undergo CT had a clinically significant missed IAI, based on clinical findings and follow-up of these patients. The 5 who had an IAI were operated based on the positivity of the FAST examination and their hemodynamic status. Thus, the detection by FAST of IAI yielded a sensitivity of 77 %, specificity of 70 %, and a negative predictive value (NPV) of 97 % (Table 1).Fig. 2

Bottom Line: CT detected intra-peritoneal fluid in 62/448 (13.8 %) of the patients with negative FAST results.This study shows that although a positive FAST evaluation does not necessarily correlate with an IAI, a negative one strongly suggests the absence of an IAI, with a high NPV.FAST examination tempered with sound clinical judgment seems to be an effective tool to discriminate injured children in need of further imaging evaluation.

View Article: PubMed Central - PubMed

Affiliation: Department of General of Surgery, Division of Surgery Rambam Health Care Campus, 8 Ha'Aliyah St, Haifa, 35254 Israel.

ABSTRACT

Introduction: In pediatric care, the role of focused abdominal sonography in trauma (FAST) remains ill defined. The objective of this study was to assess the sensitivity and specificity of FAST for detecting free peritoneal fluid in children.

Methods: The trauma registry of a single level I pediatric trauma center was queried for the results of FAST examination of consecutive pediatric (<18 years) blunt trauma patients over a period of 36 months, from January 2010 to December 2012. Demographics, type of injuries, FAST results, computerized tomography (CT) results, and operative findings were reviewed.

Results: During the study period, 543 injured pediatric patients (mean age 8.2 ± 5 years) underwent FAST examinations. In 95 (17.5 %) FAST was positive for free peritoneal fluid. CT examination was performed in 219 (40.3 %) children. Positive FAST examination was confirmed by CT scan in 61/73 (83.6 %). CT detected intra-peritoneal fluid in 62/448 (13.8 %) of the patients with negative FAST results. These findings correspond to a sensitivity of 50 %, specificity of 88 %, positive predictive value (PPV) of 84 %, and a negative predictive value (NPV) of 58 %. In patients who had negative FAST results and no CT examination (302), no missed abdominal injury was detected on clinical ground. FAST examination in the young age group (<2 years) yielded lower sensitivity and specificity (36 and 78 % respectively) with a PPV of only 50 %.

Conclusions: This study shows that although a positive FAST evaluation does not necessarily correlate with an IAI, a negative one strongly suggests the absence of an IAI, with a high NPV. These findings are emphasized in the analysis of the subgroup of children less than 2 years of age. FAST examination tempered with sound clinical judgment seems to be an effective tool to discriminate injured children in need of further imaging evaluation.

No MeSH data available.


Related in: MedlinePlus