Ultrasonographic views, landmarks, and patient-specific factors to consider in a consensus-based definition of the Focused Assessment With Sonography for Trauma in children with abdominal injury

1. A consensus was achieved among a panel of pediatric emergency point-of-care ultrasonography experts on the definitions for complete Focused Assessment With Sonography for Trauma and extended Focused Assessment With Sonography for Trauma studies using a modified Delphi technique in children with abdominal injury.

2. The definitions included ultrasonographic views, landmarks, and patient-specific factors to optimize image quality for accurate interpretation and were similar to current adult protocol definitions.

Evidence Rating Level: 4 (Below average)

Study Rundown: The accuracy and reliability of the Focused Assessment With Sonography for Trauma (FAST) and extended FAST (E-FAST) were based on data from the adult trauma patient population. Its use in the pediatric emergency setting via point-of-care ultrasonography (POCUS) is not well established and has demonstrated wide inter- and intraoperator variability in the assessment of children after blunt abdominal trauma. This qualitative study sought to develop a complete, high-quality, and accurate interpretation for FAST and E-FAST in children with injury using an expert, consensus-based modified Delphi technique. Among a panel of 26 pediatric emergency POCUS experts, a consensus was achieved on the definitions for complete FAST and E-FAST studies using a modified Delphi technique in children with abdominal injury. The definitions included ultrasonographic views, landmarks, and patient-specific factors to optimize image quality for accurate interpretation. These definitions were similar to current adult protocol definitions for FAST and E-FAST but requires further validation studies in a large pediatric patient population. A limitation of this study was that the panel consisted of international experts in pediatric emergency POCUS with advanced training in this field which may limit the generalizability and applicability of the FAST and E-FAST definitions across other centers with less volume, resources, and experience.

Click to read the study in JAMA Network Open

Relevant Reading: The role of Focused Abdominal Sonography for Trauma (FAST) in pediatric trauma evaluation

In-Depth [Survey]: This consensus-based qualitative study consisted of a panel of 26 (15 men [58%]) international experts in pediatric emergency POCUS, who completed 2 rounds of surveys and a webinar to achieve consensus in June 2021. The study used a scoping review and a modified Delphi technique to reach consensus on FAST and E-FAST definitions. For a complete FAST, 5 anatomic views – consisting of right upper-quadrant abdominal view, left upper-quadrant abdominal view, suprapubic views (transverse and sagittal), and subxiphoid cardiac view, were deemed appropriate. For E-FAST, the same FAST anatomic views in addition to the lung or pneumothorax view were deemed appropriate. Overall, the panelists rated a total of 32 landmarks, 14 statements on quality, and 20 statements on accuracy as important for assessing completeness.

Image: PD

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