California — Targeted Issue
Utility of Abdominal Ultrasound During Emergency Department Evaluation of Children with Blunt Trauma
Sept. 1, 2010 - Aug. 31, 2013

Details

Institution
University of California, Davis School of Medicine, Regents of the University of California
Principal Investigator(s)
Grant Number
H34MC19682
Award Amount
$897809.00

Regions

HRSA Region

9

EMSC Region

PREP

HPP Region

9

NASEMSO Region

West

Contacts

Name Roles Agency Mailing Address Office Phone Email
James Holmes, MD, MPH
  • Principal Investigator
University of California, Davis School of Medicine, Regents of the University of California

Disseminations

Title Published Author Abstract Publication PMID
Effect of Abdominal Ultrasound on Clinical Care, Outcomes, and Resource Use Among Children With Blunt Torso Trauma A Randomized Clinical Trial 2017 Holmes, J. F., K. M. Kelley, S. L. Wootton-Gorges, G. H. Utter, L. P. Abramson, J. S. Rose, D. J. Tancredi and N. Kuppermann Importance: The utility of the focused assessment with sonography for trauma (FAST) examination in children is unknown.

Objective: To determine if the FAST examination during initial evaluation of injured children improves clinical care.

Design, setting, and participants: A randomized clinical trial (April 2012-May 2015) 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.

Interventions: Patients were randomly assigned to a standard trauma evaluation with the FAST examination by the treating ED physician or a standard trauma evaluation alone.

Main outcomes and measures: Coprimary outcomes were rate of abdominal computed tomographic (CT) scans in the ED, missed intra-abdominal injuries, ED length of stay, and hospital charges.

Results: Among the 925 patients who were randomized (mean [SD] age, 9.7 [5.3] years; 575 males [62%]), all completed the study. A total of 50 patients (5.4%, 95% CI, 4.0% to 7.1%) were diagnosed with intra-abdominal injuries, including 40 (80%; 95% CI, 66% to 90%) who had intraperitoneal fluid found on an abdominal CT scan, and 9 patients (0.97%; 95% CI, 0.44% to 1.8%) underwent laparotomy. The proportion of patients with abdominal CT scans was 241 of 460 (52.4%) in the FAST group and 254 of 465 (54.6%) in the standard care-only group (difference, -2.2%; 95% CI, -8.7% to 4.2%). One case of missed intra-abdominal injury occurred in a patient in the FAST group and none in the control group (difference, 0.2%; 95% CI, -0.6% to 1.2%). The mean ED length of stay was 6.03 hours in the FAST group and 6.07 hours in the standard care-only group (difference, -0.04 hours; 95% CI, -0.47 to 0.40 hours). Median hospital charges were $46 415 in the FAST group and $47 759 in the standard care-only group (difference, -$1180; 95% CI, -$6651 to $4291).

Conclusions and relevance: Among hemodynamically stable children treated in an ED following blunt torso trauma, the use of FAST compared with standard care only did not improve clinical care, including use of resources; ED length of stay; missed intra-abdominal injuries; or hospital charges. These findings do not support the routine use of FAST in this setting.
Journal of the American Medical Association 28609532