Preliminary Experience With Focused Abdominal Sonography for Trauma (FAST) in Children: Is It Useful? By K.H. Mutabagani, B.D. Coley, N. Zumberge, D.W. McCarthy, G.E. Besner, D.A. Caniano, and D.R. Cooney Columbus, Ohio Background/Purpose: Most pediatric surgeons and pediatric radiologists consider computed tomography (CT) the best radiological test for the evaluation of children with suspected intraabdominal injury. The majority of injured children evalu- ated with CT will be found to have a normal scan. Focused abdominal sonographyfortrauma (FAST) has been shown to be a useful screening test in the evaluation of adult patients with suspected intraabdominal injury. Limited data exist regarding the use of FAST in children. Our aim was to evaluate the usefulness of FAST as a screening test in the evaluation of children with suspected intraabdominal injury in an attempt to minimize the number of normal CT scans performed. Methods: Hemodynamically stable children evaluated for suspected intraabdominal injurywere prospectively screened with FAST. FAST, real-time sonography at four sites, was performed by staff pediatric radiologists. The average dura- tion of the examination was 2 minutes. Positive and negative FAST scan findings were defined prospectively. The result of each FAST was recorded (positive or negative) and then all patients underwent CT as a control. All management deci- sions were based on CT results. Results: Forty-six patients were included in the study. FAST identified four children with positive findings (free intraperito- neal fluid), whereas CTshowed 13 children with injuries (nine with associated free intraperitoneal fluid and four with only solid organ injury and no associated intraperitoneal fluid). There were nine false-negative and no false-positive FAST scans. The sensitivity of FAST was 0.3 and the specificity was 1.0. Injuries missed by FAST included liver laceration, adrenal hematoma, renal laceration, small bowel injury and splenic laceration. Conclusion: Preliminary results suggest that FAST alone is not a useful screening test in the evaluation of children with suspected intraabdominal injury. J Pediatr Surg 34:48-54. Copyright o 1999 by W.B. Saunders Company. INDEX WORDS: Trauma, ultrasonography. C URRENTLY, abdominal computed tomography (CT) is considered by most pediatric surgeons and pediatric radiologists to be the diagnostic test of choice for the evaluation of children with suspected intraabdom- inal injury.‘J However, a significant number of CT scans performed in children to assessfor intraabdominal inju- ries will have normal results.’ With improving technol- ogy, ultrasonography (US) is emerging as a useful test in the evaluation of adult trauma patients. Although used more frequently in Europe and the Far East, it has increased in popularity in the United States and Canada.3-7 US is portable, requires no intravenous contrast, and has no radiation risk. Also, surgeons can be trained to perform the examination in the trauma room during resuscitation.3,8 From the English-language literature re- viewed, we noted that there are three types of sono- graphic examinations performed for the evaluation of From the Departments of Pediatric Surgery and Pediatric Radiology, The Ohio State University College of Medicine and Public Health and Children k Hospital, Columbus, OH. Address reprint requests to Khaled H. Mutabagani, MD, Division of Pediatric Surgery, New Jeddah Clinic Hospital, Medina Rd, PO Box 7692, Jeddah 21472, Saudi Arabia. Copyright o 1999 by WB. Saunders Company 0022.3468/99/3401-0010$03.00/O 48 trauma patients. The first is a very rapid and limited evaluation of four sites, three in the abdomen and pelvis and one in the thorax. This examination is aimed only at identifying free intraperitoneal blood and is known as FAST (focused abdominal sonography for trauma).8 The second type involves a slightly more extensive examina- tion in which the four sites evaluated by FAST are scanned in addition to solid organs (liver, spleen, and kidneys) and both paracolic gutters. This examination can be called a modified FAST.9 The third type is a complete examination of all regions of the abdomen and pelvis, including the retroperitoneum, with the use of Doppler to assess vascular integrity. to US examination can be per- formed in the trauma room or in the radiology department by radiology, surgery, or emergency medicine staff (resi- dents, fellows, or attending physicians).8~10-12 Many trauma centers in the United States and Canada now are perform- ing FAST as the initial screening test for the evaluation of adult patients with blunt abdominal trauma. The main use for FAST is as a screening test for the presence of blood in the peritoneal cavity. FAST is comparable to a noninvasive equivalent of the diagnostic peritoneal la- vage (DPL).13 Hemodynamically unstable patients with a positive FAST finding undergo exploration, whereas hemodynamicahy stable patients can be admitted for Journal ofPediatric Surgery, Vol 34, No 1 (January), 1999: pp 48-54