Serial Trauma Abdominal Ultrasound in Children (STAUNCH): A Multicenter Survey & Pilot Study

Publication Number: .104

Benjamin Nti, Riley Hospital for Children at Indiana University Health, Indianapolis, IN, United States; Nicole Benzoni, Washington University in St. Louis School of Medicine, Saint Louis, MO, United States; Rebecca Starr Seal, University of Louisville School of Medicine, Louisville, KY, United States; Bradley End, West Virginia University, Morgantown, WV, United States

Background: Ultrasound (US) has established utility within Pediatric Emergency Medicine (PEM) and has an added benefit of avoiding excessive radiation exposure. The serial Focused Assessment with Sonography for Trauma (FAST) examination is an under-utilized tool in pediatric trauma patients, in part due to concerns for its sensitivity.

Objective: We sought to understand current practices and viewpoints and to study whether serial US examinations can improve sensitivity compared to a single initial FAST examination in pediatric patients with blunt abdominal trauma.

Design/Methods: Thirty-three PEM institutions were surveyed regarding attitudes and practices towards serial FAST examination. Based on these results, we began a multi-center, retrospective cohort study of outcomes amongst pediatric blunt trauma patients with an initial negative or indeterminate FAST who underwent a second FAST at least 30 minutes after initial evaluation and before patient disposition. Data was collected from prior serial FAST exams, including image quality and interpretation by bedside physician. Demographics and clinical outcomes including a 30-day follow-up were collected from electronic medical records and trauma registry data. Sensitivity and specificity calculations were performed for patients with either computed tomography (CT) scans and operative reports.

Results: Among surveyed institutions that do not perform serial FAST routinely (n = 26), the most common barrier was insufficient evidence for efficacy (50%). Data collected from three institutions revealed 38 patients had serial FAST US performed between July 2017 to September 2021. The average patient age was 7.3 years old (± 4.6 years) with 12 (31.6%) female patients. Of these examinations, 6 (15.8%) resulted in a positive FAST scan after initial negative or indeterminate interpretation, 2 (5.2%) were indeterminate and 30 (78.9%) were negative. Fourteen (36.8%) patients underwent abdominal CT or operative intervention. In this population repeat US showed a sensitivity of 85.7% [confidence interval (CI) 42.1 - 99.6%] and specificity of 83.3% (95% CI 35.9 - 99.6%). There were no return visits for patients without confirmatory testing.Conclusion(s): While several barriers regarding routine serial FAST ultrasound use exist, our findings support further research into its potential utility in pediatric patients.