445 - Evaluation of Focused Assessment with Sonography for Trauma Completeness of Children in the Clinical Setting

Sunday, April 30, 2023

3:30 PM – 6:00 PM ET

Poster Number: 445
Publication Number: 445.312

Maytal Firnberg, Icahn School of Medicine at Mount Sinai, New York, NY, United States; Newton Addo, University of California, San Francisco, San Francisco, CA, United States; Margaret Lin-Martore, UCSF Benioff Children's Hospital San Francisco, San Francisco, CA, United States; Ashkon Shaahinfar, UCSF Departments of Emergency Medicine and Pediatrics, Oakland, CA, United States; Aaron E. Kornblith, UCSF Benioff Children's Hospital San Francisco, San Francisco, CA, United States

Presenting Author(s)

Maytal Firnberg, MD

Assistant Professor
Icahn School of Medicine at Mount Sinai
New York, New York, United States

Background: The accuracy of the FAST for evaluating injured children can vary significantly due to incomplete or low-quality studies. In an effort to improve the consistency and accuracy of pediatric FAST, experts established guidelines for performing a complete and high-quality FAST in children, including specific views and landmarks to be assessed. There is currently no evidence on how these guidelines compare to real-world clinical practice.

Objective:
Our study aims to assess completeness of performed FAST in children, comparing it to the established guidelines. We also aim to identify the FAST views and landmarks that are most commonly missed.

Design/Methods: We performed a retrospective review of a convenience sample of 200 FAST performed at two urban pediatric emergency departments. Routine FAST were archived and linked to patient records. Two pediatric emergency physician experts with advanced training in point-of-care ultrasound assessed and labeled all FAST for completeness using a predefined guideline of 5 views and 30 landmarks. A label applied from at least one reviewer defined a view/landmark as visualized. We compared frequencies of views/landmarks represented as medians with interquartile ranges.

Results:
200 FAST, composed of 1,636 clips, performed by 31 clinicians representing 198 children (median age of 10 years [IQR 5,14]) were reviewed and labeled. Over half (52%) of FAST visualized all 5 views. The right upper quadrant abdominal view (RUQ) was the most commonly visualized view (96.5%) whereas the suprapubic sagittal view was the least commonly visualized (65%). At the landmark level, no FAST included all landmarks; the visualization of landmarks ranged from 0-28 of 30 with a median of 19 [15,23]. The least visualized landmark in the right and left upper quadrants was the caudal edge of the liver (60%) and the splenic tip (64%), respectively. In both transverse and sagittal views, in girls, the retro-uterine space was least commonly visualized, 21% and 29% respectively.

Conclusion(s):
None of the FAST in our sample included all views and landmarks but a small majority visualized all 5 views. The least commonly visualized view was the sagittal view of the pelvis and the least commonly visualized landmark was the caudal edge of the liver; prior studies suggest these have high diagnostic importance. Future efforts should evaluate the requirements for a complete versus adequate FAST as compared to clinical outcomes in children after blunt trauma. Future educational initiatives should focus on teaching these less commonly visualized views and landmarks.