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If use of sonography improves care for adults presenting to emergency departments with possible abdominal trauma injuries, then the same approach should work with children. Right?
Not necessarily, according to a new study published in JAMA. After a randomized clinical study focusing on 925 pediatric ED patients with blunt torso trauma, no differences in key clinical outcomes were detected.
A study team from the University of California Davis used outcomes based on previous research in injured adults to assess the Focused Assessment with Sonography for Trauma (FAST), a bedside examination using a portable ultrasound machine. The goal was to determine whether FAST would lead to a decrease in the use of computed tomography (CT) scans for children, and other outcomes, without presenting safety issues.
“A lot of our work has looked at the appropriate use of CT scans in injured patients,” explained lead author James Holmes, MD, MPH, professor of emergency medicine at UC Davis. “At least in the adult trauma population, there’s evidence that you can use ultrasound to safely decrease CT use. One of the big questions has been whether that holds true for children, too.”
Children included in the study presented to the ED at UC Davis Medical Center with blunt torso injuries resulting from motor vehicle collisions, falls greater than 20 feet, and similar events. In addition to minimizing CT scan use, researchers sought to determine if the FAST protocol could lower length of stay for ED patients and decrease hospital billing charges without resulting in missed injuries.
“We were surprised that the routine use of FAST did not show any significant differences,” said Nathan Kuppermann, MD, MPH, the study's senior author and co-principal investigator. “The use of FAST compared with our standard trauma care did not decrease CT scan use, improve resource use, emergency department length of stay, safety, or hospital charges," noted Kuppermann, who is professor and chair of emergency medicine at UC Davis.
ED length-of-stay times differed by only .04 hours between the group evaluated with FAST compared with those receiving usual care, while only about $1,200 out of more than $46,000 of total charges was saved in the FAST group compared with those not receiving the ultrasound. In addition, no significant difference in missed intra-abdominal injuries was documented between the two groups.