Shaahinfar Ashkon, Wiebelhaus Jennifer Rosin, Addo Newton, Cohen Ronald A, Karakas-Rothey Pinar, Kornblith Aaron E
Department of Emergency Medicine, University of California San Francisco, San Francisco, California, USA.
Department of Pediatrics, University of California San Francisco, San Francisco, California, USA.
J Ultrasound Med. 2025 Jun;44(6):1017-1025. doi: 10.1002/jum.16661. Epub 2025 Feb 13.
To evaluate the reliability of physician gestalt estimation of pelvic free fluid volume on pediatric Focused Assessment with Sonography for Trauma (FAST). To determine a reliable cut-off volume and characteristics associated with small pelvic free fluid.
Our study assessed the ability of 2 ultrasound-trained pediatric emergency medicine (PEM) physicians and 2 pediatric radiologists to characterize pelvic free fluid in a retrospective convenience sample of archived FAST from a Level 1 pediatric trauma center, April 2018-June 2020. Inter- and intra-rater reliability were measured to determine the most reliable volume cut-off. Chi-squared and Fisher's exact tests determined characteristics associated with physiologic fluid and fluid volume.
Eighty-one (10.2%) of 797 FAST had pelvic fluid and met inclusion criteria. Volume estimates using none/trace/small versus moderate/large classifications were moderately reliable by the PEM physicians (κ = 0.65 [95% CI, 0.63-0.66]; raw agreement = 92%) and radiologists (κ = 0.48 [95% CI, 0.47-0.49]; raw agreement = 91%). This volume cut-off demonstrated higher reliability for both groups and greater agreement for PEM physicians than none/trace versus small/moderate/large. Girls (P = .005), isoechoic (P = .045), and location posterior to bladder (P < .001) were associated with physiologic fluid and hyperechoic (P = .019) with non-physiologic fluid. Hyperechoic (P < .001), anterior (P < .001), lateral (P = .04), or "other" location (P < .001) relative to the bladder were associated with moderate/large volume.
Ultrasound-trained PEM physicians and pediatric radiologists can reliably use gestalt estimation to distinguish moderate or large fluid from smaller pelvic fluid volumes on pediatric FAST.
评估在小儿创伤重点超声评估（FAST）中，医生对盆腔游离液体量的整体估计的可靠性。确定可靠的临界值以及与少量盆腔游离液体相关的特征。
我们的研究评估了2名接受过超声培训的儿科急诊医学（PEM）医生和2名儿科放射科医生，对2018年4月至2020年6月期间，来自一级儿科创伤中心的存档FAST回顾性便利样本中盆腔游离液体的特征描述能力。测量评分者间和评分者内的可靠性，以确定最可靠的体积临界值。卡方检验和费舍尔精确检验确定与生理性液体和液体量相关的特征。
797例FAST中有81例（10.2%）存在盆腔液体并符合纳入标准。PEM医生（κ = 0.65 [95% CI，0.63 - 0.66]；原始一致性 = 92%）和放射科医生（κ = 0.48 [95% CI，0.47 - 0.49]；原始一致性 = 91%）使用无/微量/少量与中度/大量分类法进行的体积估计具有中度可靠性。与无/微量与少量/中度/大量分类法相比，该体积临界值在两组中显示出更高的可靠性，且PEM医生之间的一致性更高。女孩（P = 0.005）、等回声（P = 0.045）以及膀胱后方位置（P < 0.001）与生理性液体相关，而高回声（P = 0.019）与非生理性液体相关。相对于膀胱，高回声（P < 0.001）、前方（P < 0.001）、外侧（P = 0.04）或“其他”位置（P < 0.001）与中度/大量液体相关。
接受过超声培训的PEM医生和儿科放射科医生能够可靠地使用整体估计法，在小儿FAST中区分中度或大量液体与较少的盆腔液体量。
