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J Trauma Acute Care Surg. 2019 Jan;86(1):86-91. doi: 10.1097/TA.0000000000002074.

Negative Focused Abdominal Sonography for Trauma examination predicts successful nonoperative management in pediatric solid organ injury: A prospective Arizona-Texas-Oklahoma-Memphis-Arkansas + Consortium study.

Author information

1
From the Department of Surgery, The Children's Hospital at OU Medical Center (P.M.G., P.M, Z.S., R.W.L.), Oklahoma City, Oklahoma; Pediatric Trauma Center, Dell Children's Medical Center (N.M.G., K.A.L., D.W.T.), Austin, Texas; Department of Pediatric Surgery, Children's Healthcare of Atlanta (A.B.), Atlanta, Georgia; Level I Pediatric Trauma Center, Phoenix Children's Hospital (M.E.L., C.S.L., D.M.N., D.J.O.), Phoenix, Arizona; Department of Pediatric Surgery, Arkansas Children's Hospital (R.T.M.), Little Rock, Arkansas; Department of Pediatric Surgery, Le Bonheur Children's Hospital (J.W.E.), Memphis, Tennessee; Pediatric Surgery Department, Children's Medical Center (A.C.A.), Dallas, Texas; Department of Pediatric Surgery, Akron Children's Hospital (T.A.P.), Akron, Ohio; Pediatric Surgery, American Family Children's Hospital (C.W.L.), Madison, Wisconsin; Pediatric Surgery, Mercy Children's Hospital (S.D.S.P.), Kansas City, Missouri.

Abstract

BACKGROUND:

Focused Abdominal Sonography for Trauma (FAST) examination has long been proven useful in the management of adult trauma patients, however, its utility in pediatric trauma patients is not as proven. Our goal was to evaluate the utility of a FAST examination in predicting the success or failure of nonoperative management (NOM) of blunt liver and/or spleen (BLSI) in the pediatric trauma population.

METHODS:

A retrospective analysis of a prospective observational study of patients younger than 18 years presenting with BLSI to one of ten Level I pediatric trauma centers between April 2013 and January 2016. 1,008 patients were enrolled and 292 had a FAST examination recorded. We analyzed failure of NOM of BLSI in the pediatric trauma population. We then compared FAST examination alone or in combination with the pediatric age adjusted shock index (SIPA) as it relates to success of NOM of BLSI.

RESULTS:

Focused Abdominal Sonography for Trauma examination had a negative predictive value (NPV) of 97% and positive predictive value (PPV) of 13%. The odds ratio of failing with a positive FAST examination was 4.9 and with a negative FAST was 0.20. When combined with SIPA, a positive FAST examination and SIPA had a PPV of 17%, and an odds ratio for failure of 4.9. The combination of negative FAST and SIPA had an NPV of 96%, and the odds ratio for failure was 0.20.

CONCLUSION:

Negative FAST is predictive of successful NOM of BLSI. The addition of a positive or negative SIPA score did not affect the PPV or NPV significantly. Focused Abdominal Sonography for Trauma examination may be useful clinically in determining which patients are not at risk for failure of NOM of BLSI and do not require monitoring in an intensive care setting.

LEVEL OF EVIDENCE:

Prognostic study, level IV; therapeutic/care management, level IV.

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