Focused Assessment With Sonography for Trauma in Children can help in clinical decision making: JAMA

Newly introduced definitions of complete FAST and E-FAST studies with high image quality can help in the accurate interpretation and clinical decision making in children with injury, a new study has found. These definitions are similar to those in adults with injury and may be used for future education, quality assurance, and research. The study has been published in Jama Network.

Focused assessment with sonography in trauma (FAST) is a quick bedside ultrasound examination done by emergency physicians, surgeons, and paramedics as a screening test for blood around the heart (also called a pericardial effusion) or abdominal organs (also called hemoperitoneum) after trauma. FAST is a point-of-care ultrasonography (POCUS) study that uses no radiation.

It was introduced in the US in the 1990s to describe a set of ultrasonographic views for the rapid evaluation of free fluid (hemorrhage) in patients with injury. In adult patients, use of FAST decreases time to surgical intervention, patient length of stay, surgical complications, and CT scan and diagnostic peritoneal lavage.

Currently, there is no agreed-on standard for a complete protocol, adequate image quality, and accurate interpretation for FAST in children with injury. This lack of a standardized pediatric FAST definition is a critical factor in the variability in its use, image quality, and diagnostic accuracy. Therefore, the researchers conducted this qualitative study to define a complete, high-quality, and accurate interpretation for FAST and extended FAST (E-FAST) in children with injury using an expert, consensus-based modified Delphi technique.

There were 29 invited pediatric FAST experts, out of whom 26 (15 men [58%]) agreed to participate in the panel. All 26 panelists completed the 2 rounds of surveys, and 24 (92%) participated in the live and asynchronous online discussions. The consensus was reached on FAST and E-FAST study definitions, and the panelists rated these 5 anatomic views as important and appropriate for a complete FAST: right upper-quadrant abdominal view, left upper-quadrant abdominal view, suprapubic views (transverse and sagittal), and subxiphoid cardiac view. For E-FAST, the same FAST anatomic views with the addition of the lung or pneumothorax view were deemed appropriate and important. In addition, the panelists rated a total of 32 landmarks as important for assessing completeness. Similarly, the panelists rated 14 statements on quality and 20 statements on accurate interpretation as appropriate.

In this qualitative study, the expert panel achieved consensus on the definitions for complete FAST and E-FAST studies with high image quality and accurate image interpretation in children with injury. These definitions are similar to the adult protocol definitions. The consensus statements may be used for future education, quality assurance, and research. An agreement was reached on the potential use of serial FAST studies; however, the panelists were unclear on how to clinically interpret trace volumes of abdominal free fluid, suggesting a direction for future research.

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