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 13 December 2017

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News

Abdominal ultrasound influences outcomes among children with blunt torso trauma

This week's Journal of the American Medical Association examines the effect of abdominal ultrasound on clinical care, outcomes, and resource use among children with blunt torso trauma.

News image

The utility of the focused assessment with sonography for trauma (FAST) examination in children is unknown.

Dr James Holmes and colleagues determined if the FAST examination during initial evaluation of injured children improves clinical care.

The team performed a randomized clinical trial that involved 975 hemodynamically stable children and adolescents younger than 18 years treated for blunt torso trauma at the University of California, Davis Medical Center, a level I trauma center.

Patients were randomly assigned to a standard trauma evaluation with the FAST examination by the treating emergency department physician or a standard trauma evaluation alone.

The team's main outcomes were rate of abdominal computed tomographic (CT) scans in the emergency department, missed intra-abdominal injuries, length of stay, and hospital charges.

Among the 925 patients who were randomized, all completed the study.

Median hospital charges were $46 ,415 in the FAST group
Journal of the American Medical Association

A total of 50 patients were diagnosed with intra-abdominal injuries, including 40 who had intraperitoneal fluid found on an abdominal CT scan, and 9 patients underwent laparotomy.

The researchers found that the proportion of patients with abdominal CT scans was 52% in the FAST group, and 55% in the standard care–only group.
 
The team noted that 1 case of missed intra-abdominal injury occurred in a patient in the FAST group, and none in the control group.

The researchers found that the mean emergency department length of stay was 6 hours in the FAST group, and in the standard care–only group.

Median hospital charges were $46 ,415 in the FAST group, and $47,759 in the standard care–only group.

Dr Holmes' team concludes, "Among hemodynamically stable children treated in an emergency department following blunt torso trauma, the use of FAST compared with standard care only did not improve clinical care, including use of resources."

"Emergency department length of stay; missed intra-abdominal injuries; or hospital charges."

"These findings do not support the routine use of FAST in this setting."

JAMA 2017;317(22): 2290-2296
14 June 2017

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