Test Characteristics of Focused Assessment of Sonography for Trauma for Clinically Significant Abdominal Free Fluid in Pediatric Blunt Abdominal Trauma
J. Christian Fox,Megan Boysen,Laleh Gharahbaghian,Seric Cusick,Suleman S. Ahmed,Craig L. Anderson,Michael Lekawa,Mark I. Langdorf +7 more
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TLDR
FAST has a low sensitivity for clinically important FF but has high specificity in this population of children with BAT, and a positive FAST suggests hemoperitoneum and abdominal injury, while a negative FAST aids little in decision-making.Abstract:
ACADEMIC EMERGENCY MEDICINE 2011; 18:477–482 © 2011 by the Society for Academic Emergency Medicine
Abstract
Objectives: Focused assessment of sonography in trauma (FAST) has been shown useful to detect clinically significant hemoperitoneum in adults, but not in children. The objectives were to determine test characteristics for clinically important intraperitoneal free fluid (FF) in pediatric blunt abdominal trauma (BAT) using computed tomography (CT) or surgery as criterion reference and, second, to determine the test characteristics of FAST to detect any amount of intraperitoneal FF as detected by CT.
Methods: This was a prospective observational study of consecutive children (0–17 years) who required trauma team activation for BAT and received either CT or laparotomy between 2004 and 2007. Experienced physicians performed and interpreted FAST. Clinically important FF was defined as moderate or greater amount of intraperitoneal FF per the radiologist CT report or surgery.
Results: The study enrolled 431 patients, excluded 74, and analyzed data on 357. For the first objective, 23 patients had significant hemoperitoneum (22 on CT and one at surgery). Twelve of the 23 had true-positive FAST (sensitivity = 52%; 95% confidence interval [CI] = 31% to 73%). FAST was true negative in 321 of 334 (specificity = 96%; 95% CI = 93% to 98%). Twelve of 25 patients with positive FAST had significant FF on CT (positive predictive value [PPV] = 48%; 95% CI = 28% to 69%). Of 332 patients with negative FAST, 321 had no significant fluid on CT (negative predictive value [NPV] = 97%; 95% CI = 94% to 98%). Positive likelihood ratio (LR) for FF was 13.4 (95% CI = 6.9 to 26.0) while the negative LR was 0.50 (95% CI = 0.32 to 0.76). Accuracy was 93% (333 of 357, 95% CI = 90% to 96%). For the second objective, test characteristics were as follows: sensitivity = 20% (95% CI = 13% to 30%), specificity = 98% (95% CI = 95% to 99%), PPV = 76% (95% CI = 54% to 90%), NPV = 78% (95% CI = 73% to 82%), positive LR = 9.0 (95% CI = 3.7 to 21.8), negative LR = 0.81 (95% CI = 0.7 to 0.9), and accuracy = 78% (277 of 357, 95% CI = 73% to 82%).
Conclusion: In this population of children with BAT, FAST has a low sensitivity for clinically important FF but has high specificity. A positive FAST suggests hemoperitoneum and abdominal injury, while a negative FAST aids little in decision-making.read more
Citations
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The European guideline on management of major bleeding and coagulopathy following trauma: fourth edition
Rolf Rossaint,Bertil Bouillon,Vladimir Cerny,Timothy J Coats,Jacques Duranteau,Enrique Fernández-Mondéjar,Daniela Filipescu,Beverley J. Hunt,Radko Komadina,Giuseppe Nardi,Edmund Neugebauer,Yves Ozier,Louis Riddez,Arthur Schultz,Jean Louis Vincent,Donat R. Spahn +15 more
TL;DR: The guideline now recommends that patients be transferred directly to an appropriate trauma treatment centre and encourages use of a restricted volume replacement strategy during initial resuscitation, and may also serve as a basis for local implementation.
Journal ArticleDOI
Management of bleeding and coagulopathy following major trauma: an updated European guideline
Donat R. Spahn,Bertil Bouillon,Vladimir Cerny,Timothy J Coats,Jacques Duranteau,Enrique Fernández-Mondéjar,Daniela Filipescu,Beverley J. Hunt,Radko Komadina,Giuseppe Nardi,Edmund Neugebauer,Yves Ozier,Louis Riddez,Arthur Schultz,Jean Louis Vincent,Rolf Rossaint +15 more
TL;DR: Key changes encompassed in this version of the guideline include new recommendations on the appropriate use of vasopressors and inotropic agents, and reflect an awareness of the growing number of patients in the population at large treated with antiplatelet agents and/or oral anticoagulants.
This Provisional PDF corresponds to the article as it appeared upon acceptance. Copyedited and fully formatted PDF and full text (HTML) versions will be made available soon. Management of bleeding and coagulopathy following major trauma: an updated European guideline
Donat R. Spahn,Bertil Bouillon,Timothy J Coats,Jacques Duranteau,Enrique Fernández-Mondéjar,Daniela Filipescu,Beverley J. Hunt,Giuseppe Nardi,Edmund Neugebauer,Louis Riddez,Arthur Schultz,Jean Louis Vincent +11 more
TL;DR: In this article, the authors presented an updated version of the guideline published by the Task Force for Advanced Bleeding Care in Trauma and updated in 2010, which included new recommendations on the appropriate use of vasopressors and inotropic agents.
Journal ArticleDOI
Pediatric emergency medicine point-of-care ultrasound: summary of the evidence
Jennifer R. Marin,Alyssa Abo,Alexander C. Arroyo,Stephanie J. Doniger,Jason W. Fischer,Rachel G. Rempell,Brandi Gary,James F. Holmes,David Kessler,Samuel H.F. Lam,Marla C. Levine,Jason A. Levy,Alice F. Murray,Lorraine Ng,Vicki E. Noble,Daniela Ramirez-Schrempp,David C. Riley,Turandot Saul,Vaishali P. Shah,Adam Sivitz,Ee Tein Tay,David Teng,Lindsey Chaudoin,James W. Tsung,Rebecca L. Vieira,Yaffa M. Vitberg,Resa E. Lewiss +26 more
TL;DR: This document serves as an initial step in the detailed “how to” and description of individual point-of-care ultrasound examinations for pediatric emergency medicine providers.
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Point-of-care Ultrasonography by Pediatric Emergency Medicine Physicians.
Jennifer R. Marin,Resa E. Lewiss +1 more
TL;DR: This task includes appointing leaders with expertise in point-of-care ultrasonography, effectively training and credentialing physicians in the department, and providing ongoing quality assurance reviews.
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Abdominal Injuries without Hemoperitoneum: A Potential Limitation of Focused Abdominal Sonography for Trauma (FAST)
William C. Chiu,Brad M. Cushing,Aurelio Rodriguez,Shiu M. Ho,Stuart E. Mirvis,K. Shanmuganathan,Michael D. Stein +6 more
TL;DR: Up to 29% of abdominal injuries may be missed if BTVs are evaluated with admission FAST as the sole diagnostic tool, and consideration of examination findings and associated injuries should reduce the risk of missed abdominal injury in B TVs with negative FAST results.
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