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Randomized Controlled Trial
. 2017 Jun 13;317(22):2290-2296.
doi: 10.1001/jama.2017.6322.

Effect of Abdominal Ultrasound on Clinical Care, Outcomes, and Resource Use Among Children With Blunt Torso Trauma: A Randomized Clinical Trial

James F Holmes  1 , Kenneth M Kelley  1 , Sandra L Wootton-Gorges  2 , Garth H Utter  3 , Lisa P Abramson  3 , John S Rose  1 , Daniel J Tancredi  4 , Nathan Kuppermann  5
Affiliations
Randomized Controlled Trial

Effect of Abdominal Ultrasound on Clinical Care, Outcomes, and Resource Use Among Children With Blunt Torso Trauma: A Randomized Clinical Trial

James F Holmes et al. JAMA. .

Abstract

Importance: The utility of the focused assessment with sonography for trauma (FAST) examination in children is unknown.

Objective: 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.

Interventions: 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.

Results: 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.

Trial registration: clinicaltrials.gov Identifier: NCT01540318.

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Conflict of interest statement

Conflict of Interest Disclosures: All authors have completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest and none were reported.

Figures

Figure 1.
Figure 1.. Flow Diagram of Pediatric Patients With Blunt Torso Trauma
aThe number of patients screened who met the exclusion criteria are not available. FAST indicates focused assessment with sonography for trauma.
Figure 2.
Figure 2.. Clinician Suspicion of Intra-abdominal in the FAST Group Before and After the FAST Examination
Seven patients had missing data for clinician suspicion of intra-abdominal injury either before or after the focused assessment with sonography (FAST) examination and are not included in this figure. Rows represent clinician suspicion of intra-abdominal injury prior to performing the FAST examination. Columns represent clinician suspicion of intra-abdominal injury after performing the FAST examination; data represent No. (%) of patients. The dark blue cells (diagonal) represent no change in clinician suspicion of intra-abdominal injury after the FAST examination; light blue (above the diagonal), increased clinician suspicion of intra-abdominal injury after the FAST examination; and medium blue (below the diagonal), decreased clinician suspicion of intra-abdominal injury after the FAST examination.
See this image and copyright information in PMC

Comment in

References

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