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Holmes JF, Kelley KM, Wootton-Gorges SL, et al. Effect of Abdominal Ultrasound on Clinical Care, Outcomes, and Resource Use Among Children With Blunt Torso Trauma: A Randomized Clinical Trial. JAMA. 2017;317(22):2290–2296. doi:10.1001/jama.2017.6322
Does the focused assessment with sonography for trauma (FAST) examination safely improve care when used in the emergency department (ED) evaluation of hemodynamically stable children with blunt torso trauma?
In this trial of 925 hemodynamically stable children with blunt torso trauma, randomization to the FAST vs standard trauma examination did not result in significant improvement in the rate of abdominal computed tomographic scans, time in the ED, hospital charges, or missed intra-abdominal injuries vs children randomized to standard trauma evaluation.
The study findings do not support the routine use of FAST in the ED for hemodynamically stable children with blunt torso trauma.
The utility of the focused assessment with sonography for trauma (FAST) examination in children is unknown.
To determine if the FAST examination during initial evaluation of injured children improves clinical care.
Design, Setting, and Participants
A randomized clinical trial (April 2012-May 2015) that involved 975 hemodynamically stable children and adolescents younger than 18 years treated for blunt torso trauma at the University of California, Davis Medical Center, a level I trauma center.
Patients were randomly assigned to a standard trauma evaluation with the FAST examination by the treating ED physician or a standard trauma evaluation alone.
Main Outcomes and Measures
Coprimary outcomes were rate of abdominal computed tomographic (CT) scans in the ED, missed intra-abdominal injuries, ED length of stay, and hospital charges.
Among the 925 patients who were randomized (mean [SD] age, 9.7 [5.3] years; 575 males [62%]), all completed the study. A total of 50 patients (5.4%, 95% CI, 4.0% to 7.1%) were diagnosed with intra-abdominal injuries, including 40 (80%; 95% CI, 66% to 90%) who had intraperitoneal fluid found on an abdominal CT scan, and 9 patients (0.97%; 95% CI, 0.44% to 1.8%) underwent laparotomy. The proportion of patients with abdominal CT scans was 241 of 460 (52.4%) in the FAST group and 254 of 465 (54.6%) in the standard care–only group (difference, −2.2%; 95% CI, −8.7% to 4.2%). One case of missed intra-abdominal injury occurred in a patient in the FAST group and none in the control group (difference, 0.2%; 95% CI, −0.6% to 1.2%). The mean ED length of stay was 6.03 hours in the FAST group and 6.07 hours in the standard care–only group (difference, −0.04 hours; 95% CI, −0.47 to 0.40 hours). Median hospital charges were $46 415 in the FAST group and $47 759 in the standard care–only group (difference, −$1180; 95% CI, −$6651 to $4291).
Conclusions and Relevance
Among hemodynamically stable children treated in an ED following blunt torso trauma, the use of FAST compared with standard care only did not improve clinical care, including use of resources; ED length of stay; missed intra-abdominal injuries; or hospital charges. These findings do not support the routine use of FAST in this setting.
clinicaltrials.gov Identifier: NCT01540318
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