Holmes James F, Kelley Kenneth M, Wootton-Gorges Sandra L, Utter Garth H, Abramson Lisa P, Rose John S, Tancredi Daniel J, Kuppermann Nathan
Department of Emergency Medicine, University of California, Davis School of Medicine, Sacramento.
Department of Radiology, University of California, Davis School of Medicine, Sacramento.
JAMA. 2017 Jun 13;317(22):2290-2296. doi: 10.1001/jama.2017.6322.
The utility of the focused assessment with sonography for trauma (FAST) examination in children is unknown.
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.
Patients were randomly assigned to a standard trauma evaluation with the FAST examination by the treating ED physician or a standard trauma evaluation alone.
Coprimary outcomes were rate of abdominal computed tomographic (CT) scans in the ED, missed intra-abdominal injuries, ED length of stay, and hospital charges.
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).
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.
clinicaltrials.gov Identifier: NCT01540318.
针对儿童的创伤重点超声评估（FAST）检查的效用尚不清楚。
确定在对受伤儿童进行初始评估时进行FAST检查是否能改善临床护理。
设计、地点和参与者：一项随机临床试验（2012年4月至2015年5月），涉及975名在加利福尼亚大学戴维斯分校医学中心（一级创伤中心）接受钝性躯干创伤治疗的血流动力学稳定的18岁以下儿童和青少年。
患者被随机分配接受由急诊科主治医生进行的FAST检查的标准创伤评估或仅接受标准创伤评估。
共同主要结局为急诊科腹部计算机断层扫描（CT）扫描率、漏诊的腹腔内损伤、急诊科住院时间和医院费用。
在925名随机分组的患者中（平均[标准差]年龄为9.7[5.3]岁；575名男性[62%]），所有患者均完成了研究。共有50名患者（5.4%，95%置信区间，4.0%至7.1%）被诊断为腹腔内损伤，其中40名（80%；95%置信区间，66%至90%）在腹部CT扫描中发现腹腔内有积液，9名患者（0.97%；95%置信区间，0.44%至1.8%）接受了剖腹手术。FAST组460名患者中有241名（52.4%）进行了腹部CT扫描，仅接受标准护理组465名患者中有254名（54.6%）进行了腹部CT扫描（差异为-2.2%；95%置信区间，-8.7%至4.2%）。FAST组有1例腹腔内损伤漏诊，对照组无漏诊病例（差异为0.2%；95%置信区间，-0.6%至1.2%）。FAST组的急诊科平均住院时间为6.03小时，仅接受标准护理组为6.07小时（差异为-0.04小时；95%置信区间，-0.47至0.40小时）。FAST组的医院费用中位数为46415美元，仅接受标准护理组为47759美元（差异为-1180美元；95%置信区间，-6651美元至4291美元）。
在急诊科接受钝性躯干创伤治疗的血流动力学稳定的儿童中，与仅采用标准护理相比，使用FAST并未改善临床护理，包括资源使用、急诊科住院时间、漏诊的腹腔内损伤或医院费用。这些发现不支持在此情况下常规使用FAST。
clinicaltrials.gov标识符：NCT01540318。
