Objective: to determine whether FAST examination during initial evaluation of children with blunt torso trauma improves clinical care.
Design: randomised clinical trial (RCT).
Setting: level I trauma centre at the University of California Davis Medical Center.
Study population: 925 patients aged less than 18 years with blunt torso trauma and haemodynamically stable.
Intervention: the study included 925 patients aged less than 18 years with blunt torso trauma who were haemodynamically stable. The inclusion and exclusion criteria were complex and appropriate for the identification of a study population with an approximate 5% risk of intra-abdominal injury. Participants were randomised to two groups: those that underwent FAST examination (intervention group [IG]) and those that did not undergo FAST examination at the outset and instead received standard care for stable blunt torso trauma (control group [CG]).
Outcome measurement: the outcome variables were: performance of abdominal computed tomography (CT) scans (%), rate of missed intra-abdominal injuries (%), emergency department length of stay (hours), and hospital charges (in US dollars). The sample size calculation took into account every primary outcome assuming an α error of 0.05 and a beta error of 0.2 (power of 80%). The authors used the Fisher exact and Student t tests in the statistical analysis.
Main results: of the 925 patients under study, 50 had intra-abdominal injuries (5.4%), 95% confidence interval (95 CI): 4 to 7.1; including 40 in who free intraperitoneal fluid was detected by abdominal CT scan (80%; 95 CI: 66 to 90) and 9 that required laparotomy (0.97%; 95 CI: 0.44 to 1.8). The proportion of patients that underwent an abdominal CT scan in the IG was 241 out of 460 (52.4%), compared to 254 out of 465 in the CG (54.6%), with a difference of -2.2% between the groups (95 CI: -8.7 to 4.2). There was one case of missed intra-abdominal injury in the IG and none in the CG, which corresponds to a difference of 0.2% (95 CI: -0.6 to 1.2). The mean length of stay was 6.03 hours in the IG and 6.07 hours in the CG, with a difference of -0.04 hours (95 CI: -0.47 to 0.4 hours). The median hospital charges in the IG was 46 415 US dollars, compared to 47 759 in the CG (a difference of -1180 dollars; 95 CI: -6651 to 4291).
Conclusion: the use of FAST in paediatric emergency care does not improve the care of patients with blunt torso trauma who are stable, increase the detection of missed intra-abdominal injuries or decrease the length of stay in the emergency department or hospital charges. The data obtained in the study does not support the routine use of FAST in the paediatric emergency department.
Conflicts of interest: none disclosed.
Funding source: the study was supported by grant H34MC19682 from the Emergency Medical Services for Children.