Role of focused assessment with sonography for trauma as a screening tool for blunt abdominal trauma in young children after high energy trauma

  • Willemieke SFJ Tummers University of Cape Town
  • Joost van Schuppen Academic Medical Centre
  • Hester R Langeveld Sophia’s Children Hospital/Erasmus Medical Centre
  • Jim CH Wilde Emma's Children Hospital/Academic Medical Centre
  • Ebrahim Banderker University of Cape Town
  • Sebastian B van As University of Cape Town
Keywords: FAST, abdominal trauma, HET, screening, children

Abstract

Background: The objective of the study was to review the utility of focused assessement with sonography for trauma (FAST) as a screening tool for blunt abdominal trauma (BAT) in children involved in high energy trauma (HET), and to determine whether a FAST could replace computed tomography (CT) in clinical decision-making regarding paediatric BAT.

Method: Children presented at the Trauma Unit of the Red Cross War Memorial Children’s Hospital, Cape Town, after HET, and underwent both a physical examination and a FAST. The presence of free fluid in the abdomen and pelvis was assessed using a FAST. Sensitivity, specificity, and positive and negative predictive values (PPV and NPV) for identifying intraabdominal injury were calculated for the physical examination and the FAST, both individually and when combined.

Results: Seventy-five patients were included as per the criteria for HET as follows: pedestrian motor vehicle crashes (MVCs) (n = 46), assault (n = 14), fall from a height (n = 9), MVC passenger (n = 4) and other (n = 2). The ages of the patients ranged from 3 months to 13 years. The sensitivity of the physical examination was 0.80, specificity 0.83, PPV 0.42 and NPV 0.96. The sensitivity of the FAST was 0.50, specificity 1.00, PPV 1.00 and NPV 0.93. Sensitivity increased to 0.90 when the physical examination was combined with the FAST. Nonoperative management was used in 73 patients. Two underwent an operation.

Conclusion: A FAST should be performed in combination with a physical examination on every paediatric patient involved in HET to detect BAT. When both are negative, nonoperative management can be implemented without fear of missing a clinically significant injury. FAST is a safe, effective and easily accessible alternative to CT, which avoids ionising radiation and aids in clinical decision-making.

Author Biographies

Willemieke SFJ Tummers, University of Cape Town
Department of Trauma and Paediatric Surgery
Red Cross War Memorial Children's Hospital
University of Cape Town
South Africa

Joost van Schuppen, Academic Medical Centre

Department of Radiology
Academic Medical Centre
Amsterdam
The Netherlands

 

Hester R Langeveld, Sophia’s Children Hospital/Erasmus Medical Centre
Department of Paediatric Surgery
Sophia’s Children Hospital/Erasmus Medical Centre
Rotterdam
The Netherlands
Jim CH Wilde, Emma's Children Hospital/Academic Medical Centre

Department of Paediatric Surgery
Emma's Children Hospital/Academic Medical Centre
Amsterdam
The Netherlands

 

Ebrahim Banderker, University of Cape Town

Department of Radiology
Red Cross War Memorial Children's Hospital
University of Cape Town
South Africa

 

Sebastian B van As, University of Cape Town

Department of Trauma, Paediatric Surgery
Red Cross War Memorial Children's Hospital
University of Cape Town
South Africa

 

 

Published
2016-06-29
How to Cite
Tummers, W., van Schuppen, J., Langeveld, H., Wilde, J., Banderker, E., & van As, S. (2016). Role of focused assessment with sonography for trauma as a screening tool for blunt abdominal trauma in young children after high energy trauma. South African Journal of Surgery, 54(2), 28-34. Retrieved from http://sajs.redbricklibrary.co.za/index.php/sajs/article/view/1937
Section
Paediatric Surgery