Today, I reviewed and linked to Emergency Medicine Cases‘ Pediatric FAST-Useful/Useless? from EM Quick Hits 48 – FAST in Pediatric Trauma, Multiple Myeloma, Drowning, AKA, Global EM.*
*Helman, A. Cary, H. Rosenberg, H. McCurdy, A. Jerome, D. Long, B. Gottlieb, M. Sahsi, N. EM Quick Hits 48 – FAST in Pediatric Trauma, Multiple Myeloma, Drowning, AKA, Global EM. Emergency Medicine Cases. April, 2023. https://emergencymedicinecases.com/em-quick-hits-april-2023/. Accessed May 3, 2023.
All that follows is from Pediatric FAST-Useful/Useless? by Heather Cary:
Abdominal FAST exam does not improve outcomes and may complicate pediatric traumas
- Despite abdominal FAST exams being commonly used in North America, literature suggests that FAST has low sensitivity (estimated to be 28% for EM physicians) and high false-negative rate without improving clinical outcomes
- Only two-thirds of children with intraabdominal injuries would have positive FAST with free fluid
- As the majority of intraabdominal injuries are managed conservatively, providers should avoid using positive FAST as the deciding factor to order abdominal CT. They should instead use the clinical picture of the patient and indications such as:
- Significant abdominal wall trauma
- Seatbelt or handlebar sign
- GCS < 14 in blunt abdominal wall trauma
- Abdominal tenderness and/or distention
- Persistent hypovolemia
- PR/NG blood
- Gross hematuria
- Suspected pelvic fracture
