Consensus-based definition on sonogram helpful for pediatric trauma patients: JAMA
USA: Consensus definitions for the assessment of children with injury through sonography could be helpful in the emergency department, states a recent study in JAMA Network Open.
Explaining the results Aaron E. Kornblith, Department of Pediatrics, University of California, San Francisco, San Francisco, and colleagues wrote, "the study generated definitions for complete Focused Assessment With Sonography for Trauma (FAST) and the extended FAST (E-FAST) studies with high image quality and accurate interpretation in children with injury." "These definitions are similar to those in adults with injury and may be utilized for future education, research, and quality assurance."
The broad variation in the accuracy and reliability of the FAST and the E-FAST for children following blunt abdominal trauma reflects user expertise.FAST and E-FAST that are performed by experts tend to be more complete, better quality, and more often clinically valuable. Considering this, Dr. Kornblith and colleagues aimed to develop definitions of a complete, high-quality, and accurate interpretation for the FAST and E-FAST in children with injury using an expert, consensus-based modified Delphi technique in a consensus-based qualitative study.
The study was conducted between May 1 to June 30, 2021. Scoping review and iterative Delphi technique was used and involved 2 rounds of online surveys and a live webinar to achieve consensus among a 26-member panel. The panel included international experts in pediatric emergency point-of-care ultrasonography.
The main outcome and measures included definitions of complete, high-quality, and accurate FAST and E-FAST studies for children after injury.
Following were the study's salient findings:
- Of the 29 invited pediatric FAST experts, 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.
- 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.
- 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.
The authors concluded, "the definitions established in this study may assist clinicians in completing the necessary components of FAST or extended FAST for children with injury and may be used for future education, quality assurance, and research."
Kornblith AE, Addo N, Plasencia M, et al. Development of a Consensus-Based Definition of Focused Assessment With Sonography for Trauma in Children. JAMA Netw Open. 2022;5(3):e222922. doi:10.1001/jamanetworkopen.2022.2922