title: Role of focused assessment with sonography for trauma as a screening tool for blunt abdominal trauma in young children after high energy trauma.
abstract: BACKGROUND
  The objective of the study was to review the utility of focused assessement with sonography for trauma (FAST) as a screening tool for blunt abdominal trauma (BAT) in children involved in high energy trauma (HET), and to determine whether a FAST could replace computed tomography (CT) in clinical decision-making regarding paediatric BAT.
  
  
  METHODS
  Children presented at the Trauma Unit of the Red Cross War Memorial Children's Hospital, Cape Town, after HET, and underwent both a physical examination and a FAST. The presence of free fluid in the abdomen and pelvis was assessed using a FAST. Sensitivity, specificity, and positive and negative predictive values (PPV and NPV) for identifying intraabdominal injury were calculated for the physical examination and the FAST, both individually and when combined.
  
  
  RESULTS
  Seventy-five patients were included as per the criteria for HET as follows: pedestrian motor vehicle crashes (MVCs) (n= 46), assault (n= 14), fall from a height (n= 9), MVC passenger (n= 4) and other (n= 2). The ages of the patients ranged from 3 months to 13 years. The sensitivity of the physical examination was 0.80, specificity 0.83, PPV 0.42 and NPV 0.96. The sensitivity of the FAST was 0.50, specificity 1.00, PPV 1.00 and NPV 0.93. Sensitivity increased to 0.90 when the physical examination was combined with the FAST. Nonoperative management was used in 73 patients. Two underwent an operation.
  
  
  CONCLUSIONS
  A FAST should be performed in combination with a physical examination on every paediatric patient involved in HET to detect BAT. When both are negative, nonoperative management can be implemented without fear of missing a clinically significant injury. FAST is a safe, effective and easily accessible alternative to CT, which avoids ionising radiation and aids in clinical decision-making.
authors.affiliation: Department of Trauma and Paediatric Surgery, Red Cross War Memorial Children's Hospital, University of Cape Town, South Africa.
authors.forename: W
authors.initials: W
authors.lastname: Tummers
authors.affiliation: Department of Radiology, Academic Medical Centre, Amsterdam, The Netherlands.
authors.forename: J
authors.initials: J
authors.lastname: van Schuppen
authors.affiliation: Department of Paediatric Surgery, Sophia's Children Hospital/Erasmus Medical Centre, Rotterdam, The Netherlands.
authors.forename: H
authors.initials: H
authors.lastname: Langeveld
authors.affiliation: Department of Paediatric Surgery, Emma's Children Hospital/Academic Medical Centre, Amsterdam, The Netherlands.
authors.forename: J
authors.initials: J
authors.lastname: Wilde
authors.affiliation: Department of Radiology, Red Cross War Memorial Children's Hospital, University of Cape Town, South Africa.
authors.forename: E
authors.initials: E
authors.lastname: Banderker
authors.affiliation: Department of Trauma and Paediatric Surgery, Red Cross War Memorial Children's Hospital, University of Cape Town, South Africa.
authors.forename: A
authors.initials: A
authors.lastname: van As