Department of Pediatrics, University of California, San Francisco, San Francisco.
Department of Emergency Medicine, University of California, San Francisco, San Francisco.
JAMA Netw Open. 2022 Mar 1;5(3):e222922. doi: 10.1001/jamanetworkopen.2022.2922.
The wide variation in the accuracy and reliability of the Focused Assessment With Sonography for Trauma (FAST) and the extended FAST (E-FAST) for children after blunt abdominal trauma reflects user expertise. FAST and E-FAST that are performed by experts tend to be more complete, better quality, and more often clinically valuable.
To develop definitions of a complete, high-quality, and accurate interpretation for the FAST and E-FAST in children with injury using an expert, consensus-based modified Delphi technique.
DESIGN, SETTING, AND PARTICIPANTS: This consensus-based qualitative study was conducted between May 1 to June 30, 2021. It used a scoping review and iterative Delphi technique and involved 2 rounds of online surveys and a live webinar to achieve consensus among a 26-member panel. This panel consisted of international experts in pediatric emergency point-of-care ultrasonography.
Definitions of complete, high-quality, and accurate FAST and E-FAST studies for children after injury.
Of the 29 invited pediatric FAST experts, 26 (15 men [58%]) agreed to participate in the panel. All 26 panelists completed the 2 rounds of surveys, and 24 (92%) participated in the live and asynchronous online discussions. Consensus was reached on FAST and E-FAST study definitions, and the panelists rated these 5 anatomic views as important and appropriate for a complete FAST: right upper-quadrant abdominal view, left upper-quadrant abdominal view, suprapubic views (transverse and sagittal), and subxiphoid cardiac view. For E-FAST, the same FAST anatomic views with the addition of the lung or pneumothorax view were deemed appropriate and important. In addition, the panelists rated a total of 32 landmarks as important for assessing completeness. Similarly, the panelists rated 14 statements on quality and 20 statements on accurate interpretation as appropriate.
This qualitative study generated definitions for complete FAST and E-FAST studies with high image quality and accurate interpretation in children with injury. These definitions are similar to those in adults with injury and may be used for future education, quality assurance, and research. Future research may focus on interpretation of trace volumes of abdominal free fluid and the use of serial FAST.
在对钝性腹部创伤后的儿童进行创伤重点超声评估（FAST）和扩展 FAST（E-FAST）时，准确性和可靠性差异很大，这反映了使用者的专业水平。由专家进行的 FAST 和 E-FAST 往往更完整、质量更高，并且更有临床价值。
使用专家共识的改良 Delphi 技术，为受伤儿童的 FAST 和 E-FAST 制定完整、高质量和准确解读的定义。
设计、设置和参与者：这项基于共识的定性研究于 2021 年 5 月 1 日至 6 月 30 日进行。它使用了范围综述和迭代 Delphi 技术，涉及两轮在线调查和一次网络研讨会，以实现由 26 名成员组成的专家组之间的共识。该专家组由儿科急诊即时超声检查领域的国际专家组成。
受伤儿童完整、高质量和准确的 FAST 和 E-FAST 研究的定义。
在 29 名受邀的儿科 FAST 专家中，有 26 名（15 名男性[58%]）同意参加专家组。所有 26 名小组成员都完成了两轮调查，24 名（92%）参加了现场和异步在线讨论。就 FAST 和 E-FAST 研究定义达成了共识，小组成员认为以下 5 个解剖视图对于完整的 FAST 很重要且合适：右上腹部视图、左上腹部视图、耻骨上视图（横切和矢状切）和剑突下心脏视图。对于 E-FAST，同样的 FAST 解剖视图加上肺部或气胸视图被认为是合适和重要的。此外，小组成员还认为总共 32 个地标对于评估完整性很重要。同样，小组成员认为 14 项关于质量的声明和 20 项关于准确解释的声明是合适的。
这项定性研究针对受伤儿童生成了具有高质量图像和准确解读的完整 FAST 和 E-FAST 研究的定义。这些定义与受伤成人的定义相似，可用于未来的教育、质量保证和研究。未来的研究可能集中在腹部游离液体微量的解读和连续 FAST 的使用上。
