title: Use of the focused assessment with sonography for trauma (FAST) examination and its impact on abdominal computed tomography use in hemodynamically stable children with blunt torso trauma.
abstract: BACKGROUND
  The aim of this study was to evaluate the variability of clinician-performed Focused Assessment with Sonography for Trauma (FAST) examinations and its impact on abdominal computed tomography (AbCT) use in hemodynamically stable children with blunt torso trauma (BTT). The FAST is used with variable frequency in children with BTT.
  
  
  METHODS
  We performed a planned secondary analysis of children (<18 years) with BTT. Patients with a Glasgow Coma Scale (GCS) score of less than 9, those with hypotension, and those taken directly to the operating suite were excluded. Clinicians documented their suspicion for intra-abdominal injury (IAI) as very low, less than 1%; low, 1% to 5%; moderate, 6% to 10%; high, 11% to 50%; or very high, greater than 50%. We determined the relative risk (RR) for AbCT use based on undergoing a FAST examination in each of these clinical suspicion strata.
  
  
  RESULTS
  Of 6,468 (median age, 11.8 years; interquartile range, 6.3-15.5 years) children who met eligibility, 887 (13.7%) underwent FAST examination before CT scan. A total of 3,015 (46.6%) underwent AbCT scanning, and 373 (5.8%) were diagnosed with IAI. Use of the FAST increased as clinician suspicion for IAI increased, 11.0% with less than 1% suspicion for IAI, 13.5% with 1% to 5% suspicion, 20.5% with 6% to 10% suspicion, 23.2% with 11% to 50% suspicion, and 30.7% with greater than 50% suspicion. The patients in whom the clinicians had a suspicion of IAI of 1% to 5% or 6% to 10% were significantly less likely to undergo a CT scan if a FAST examination was performed: RR, 0.83 (0.67-1.03); RR, 0.81 (0.72-0.91); RR, 0.85 (0.78-0.94); RR, 0.99 (0.94-1.05); and RR, 0.97 (0.91-1.05) for patients with clinician suspicion of IAI of less than 1%, 1% to 5%, 6% to 10%, 11% to 50%, and greater than 50%, respectively.
  
  
  CONCLUSIONS
  The FAST examination is used in a relatively small percentage of children with BTT. Use increases as clinician suspicion for IAI increases. Patients with a low or moderate clinician suspicion of IAI are less likely to undergo AbCT if they receive a FAST examination. A randomized controlled trial is required to more precisely determine the benefits and drawbacks of the FAST examination in the evaluation of children with BTT.
  
  
  METHODS
  Prognostic and epidemiologic study, II.
authors.affiliation: From the Department of Surgery (J.M.), University of Maryland, Baltimore, Maryland; Department of Pediatrics (S.B.), Jacobi Medical Center, Bronx, New York; Department of Surgery (D.H.W.), University of California Davis Medical Center, Sacramento, California; Department of Pediatrics (P.S.D.), Columbia University, New York, New York; Department of Pediatrics and Emergency Medicine (M.T.), New York University, New York, New York; Department of Pediatrics (M.G.), University of Rochester, Rochester, New York; Department of Pediatrics (P.M.), Wayne State University, Detroit, Michigan; Department of Pediatrics (K.P.), University of Utah, Salt Lake City, Utah; Department of Emergency Medicine (D.M.), Howard County Hospital, Columbia, Maryland; Department of Emergency Medicine (D.B.), Hurley Medical Center, Flint, Michigan; and Department of Emergency Medicine (N.K., J.F.H.), University of California, Davis, Sacramento, California.
authors.forename: Jay
authors.initials: J
authors.lastname: Menaker
authors.forename: Stephen
authors.initials: S
authors.lastname: Blumberg
authors.forename: David H
authors.initials: DH
authors.lastname: Wisner
authors.forename: Peter S
authors.initials: PS
authors.lastname: Dayan
authors.forename: Michael
authors.initials: M
authors.lastname: Tunik
authors.forename: Madelyn
authors.initials: M
authors.lastname: Garcia
authors.forename: Prashant
authors.initials: P
authors.lastname: Mahajan
authors.forename: Kent
authors.initials: K
authors.lastname: Page
authors.forename: David
authors.initials: D
authors.lastname: Monroe
authors.forename: Dominic
authors.initials: D
authors.lastname: Borgialli
authors.forename: Nathan
authors.initials: N
authors.lastname: Kuppermann
authors.forename: James F
authors.initials: JF
authors.lastname: Holmes
mesh_terms: D000007:Abdominal Injuries / Q000000981:diagnostic imaging* / Q000503:physiopathology; D000293:Adolescent; D002648:Child; D005260:Female; D006439:Hemodynamics; D006801:Humans; D008297:Male; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data; D011446:Prospective Studies; D012306:Risk; D013898:Thoracic Injuries / Q000000981:diagnostic imaging* / Q000503:physiopathology; D014057:Tomography, X-Ray Computed / Q000706:statistics & numerical data; D014463:Ultrasonography; D014949:Wounds, Nonpenetrating / Q000000981:diagnostic imaging* / Q000503:physiopathology