Inci Ozlem, Altuncı Yusuf Ali, Can Ozge, Akarca Funda Karbek, Ersel Murat
Department of Emergency Medicine, Batman Education and Research Hospital, Batman, Turkey.
Department of Emergency, Faculty of Medicine, Ege University, Izmir, Turkey.
J Emerg Trauma Shock. 2024 Jan-Mar;17(1):8-13. doi: 10.4103/jets.jets_137_22. Epub 2023 Dec 4.
Focused Assessment with Sonography for Trauma (FAST) has attracted attention for its use in the detection of intra-abdominal pathology for pediatric patients. However, computed tomography (CT) remains the gold standard for the assessment of blunt torso trauma. The study examines the effectiveness of FAST both in the detection of intra-abdominal pathology in pediatric patients (<19 years) with blunt torso trauma and in the determination of the need for CT for further examination.
The study was designed as a retrospective observational investigation of diagnostic value. The pediatric patients who were admitted to the Emergency Department with blunt torso trauma between January 2013 and October 2016 were included in the study. The sample of the study comprised 255 patients who met the inclusion criteria. The primary outcome was the effectiveness of FAST in the detection of intra-abdominal pathology and the determination of the need for CT. The secondary outcome was to identify the agreement between CT and FAST for intra-abdominal injuries. The Chi-square test and Fisher's exact test were used for comparisons. A logistic regression model was developed to determine the variables that independently affect the agreement between FAST and CT.
FAST was determined to have low sensitivity (20.3%) despite its high specificity (87%). However; FAST had a good negative likelihood ratio. There was a poor agreement between CT and FAST in terms of the presence of both intra-abdominal and intrathoracic injuries in pediatric patients with blunt trunk trauma. The error rate of FAST increased by five-fold, especially in the presence of concomitant thorax trauma. However, FAST had a good negative likelihood ratio.
FAST should not be regarded as an equivalent tool to CT for pediatric patients with blunt torso trauma. It is, instead, a noteworthy complementary tool that is a negative predictor.
创伤超声重点评估（FAST）因其在检测儿科患者腹腔内病变中的应用而受到关注。然而，计算机断层扫描（CT）仍然是评估钝性躯干创伤的金标准。本研究旨在探讨FAST在检测钝性躯干创伤的儿科患者（<19岁）腹腔内病变以及确定是否需要进行CT进一步检查方面的有效性。
本研究设计为一项关于诊断价值的回顾性观察性调查。纳入2013年1月至2016年10月期间因钝性躯干创伤入住急诊科的儿科患者。研究样本包括255名符合纳入标准的患者。主要结局是FAST在检测腹腔内病变和确定是否需要CT方面的有效性。次要结局是确定CT与FAST在腹腔内损伤诊断上的一致性。采用卡方检验和Fisher精确检验进行比较。建立逻辑回归模型以确定独立影响FAST与CT一致性的变量。
尽管FAST具有较高的特异性（87%），但其敏感性较低（20.3%）。然而，FAST具有良好的阴性似然比。在钝性躯干创伤的儿科患者中，CT与FAST在腹腔内和胸腔内损伤的诊断方面一致性较差。FAST的错误率增加了五倍，尤其是在伴有胸部创伤的情况下。然而，FAST具有良好的阴性似然比。
对于钝性躯干创伤的儿科患者，不应将FAST视为等同于CT的工具。相反，它是一种值得注意的补充工具，是一种阴性预测指标。
