Identifying Children at Very Low Risk for Blunt Intra-Abdominal Injury in Whom CT of the Abdomen Can Be Avoided Safely

Streck, Christian J.; Vogel, Adam M.; Zhang, Jingwen; Huang, Eunice Y.; Santore, Matthew T.; Tsao, KuoJen; Falcone, Richard A.; Dassinger, Melvin S.; Russell, Robert T.; Blakely, Martin L.; Mauldin, Patrick D.; Calder, Bennett W.; Savoie, Kate B.; Haynes, Jeffrey H.; Naik‐Mathuria, Bindi; Peter, Shawn D. St.; Mooney, David P.; Onwubiko, Chinwendu; Upperman, Jeffrey S.

doi:10.1016/j.jamcollsurg.2016.12.041

Cited by 70 publications

(66 citation statements)

References 30 publications

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“…However, the cohort of patients included in our study appears to be representative of previous reports. The incidence of IAI in this cohort was 14%, which was similar to the 10% to 15% rate of IAI in other studies, 9,38,39 but different than the rate reported by Holmes et al, 10 6.3%. Importantly, in this study, the choice to perform a FAST was left to the discretion of the treating provider, and we believe that children who did not receive a FAST may have had a lower suspicion for injury than those who did.…”

Section: Limitationssupporting

confidence: 78%

“…However, the two most rigorous and recent prediction rules were developed without the focused assessment with sonography for trauma (FAST) examination, because many study sites were lacking expertise and a standard implementation pathway. 10,13,14 Focused assessment with sonography for trauma is a bedside sonographic evaluation performed within minutes of the patient's arrival by the treating provider, in conjunction with the physical examination, to rapidly identify intraperitoneal traumatic hemorrhage. 15 FAST has been successfully integrated into the management of injured adult patients where it improves clinical outcomes including reducing CT scan usage.…”

mentioning

confidence: 99%

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The Utility of Focused Assessment With Sonography for Trauma Enhanced Physical Examination in Children With Blunt Torso Trauma

Kornblith

Graf

Addo

et al. 2020

Academic Emergency Medicine

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Objectives Computed tomography (CT), the reference standard for diagnosis of intraabdominal injury (IAI), carries risk including ionizing radiation. CT‐sparing clinical decision rules for children have relied heavily on physical examination, but they did not include focused assessment with sonography for trauma (FAST), which has emerged into widespread use during the past decade. We sought to determine the independent associations of physical examination, laboratory studies, and FAST with identification of IAI in children and to compare the test characteristics of these diagnostic variables. We hypothesized that FAST may add incremental utility to a physical examination alone to more accurately identify children who could forgo CT scan. Methods We reviewed a large trauma database of all children with blunt torso trauma presenting to a freestanding pediatric emergency department during a 20‐month period. We used logistic regression to evaluate the association of FAST, physical examination, and selected laboratory data with IAI in children, and we compared the test characteristics of these variables. Results Among 354 children, 50 (14%) had IAI. Positive FAST (odds ratio [OR] = 14.8, 95% confidence interval [CI] = 7.5 to 30.8) and positive physical examination (OR = 15.2, 95% CI = 7.7 to 31.7) were identified as independent predictors for IAI. Physical examination and FAST each had sensitivities of 74% (95% CI = 60% to 85%). Combining FAST and physical examination as FAST‐enhanced physical examination (exFAST) improved sensitivity and negative predictive value (NPV) over either test alone (sensitivity = 88%, 95% CI = 76% to 96%) and NPV of 97.3% (95% CI = 94.5% to 98.7%). Conclusions In children, FAST and physical examinations each predicted the identification of IAI. However, the combination of the two (exFAST) had greater sensitivity and NPV than either physical examination or FAST alone. This supports the use of exFAST in refining clinical predication rules in children with blunt torso trauma.

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Section: Limitationssupporting

confidence: 78%

mentioning

confidence: 99%

The Utility of Focused Assessment With Sonography for Trauma Enhanced Physical Examination in Children With Blunt Torso Trauma

Kornblith

Graf

Addo

et al. 2020

Academic Emergency Medicine

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“…This is in line with other studies showing that the majority of children with blunt abdominal trauma present to adult trauma centers and more than half of them undergo abdominal CT as part of their trauma evaluation. [ 18 , 19 ]…”

Section: Discussionmentioning

confidence: 99%

“…[ 3 ] There are several guidelines for the identification of children with low and very low risk for IAI in whom abdominal CT scanning can be safely avoided. [ 18 , 20 ] However, the variability of CT usage among different centers shows that physicians do not consistently apply evidence-based decision instruments in their daily practice. [ 21 ]…”

Section: Discussionmentioning

confidence: 99%

Pediatric solid organ injury – frequency of abdominal imaging is determined by the treating department

et al. 2020

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“…5–7 With the known risks of CT imaging, investigators have sought to identify patient history and physical examination findings, plus ultrasound and laboratory results, that identify children at very low risk for intra-abdominal injury and thus may not require CT scanning. 8–16 Prediction models have used a variety of physical examination components including subjective findings (e.g. abdominal tenderness or complaints of pain) and objective findings (e.g.…”

Section: Introductionmentioning

confidence: 99%

Costal Margin Tenderness and the Risk for Intraabdominal Injuries in Children With Blunt Abdominal Trauma

Flynn-OʼBrien

Kuppermann

Holmes

2018

Academic Emergency Medicine

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Identifying Children at Very Low Risk for Blunt Intra-Abdominal Injury in Whom CT of the Abdomen Can Be Avoided Safely

Cited by 70 publications

References 30 publications

The Utility of Focused Assessment With Sonography for Trauma Enhanced Physical Examination in Children With Blunt Torso Trauma

The Utility of Focused Assessment With Sonography for Trauma Enhanced Physical Examination in Children With Blunt Torso Trauma

Pediatric solid organ injury – frequency of abdominal imaging is determined by the treating department

Costal Margin Tenderness and the Risk for Intraabdominal Injuries in Children With Blunt Abdominal Trauma

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