Use of FAST is less common in pediatric trauma than in adult trauma
FAST in pediatric trauma has a lower negative predictive value than in adults
1/3 of pediatric patients with hemoperitoneum on CT will have a negative FAST
Lowest sensitivity and specificity is in the under 2 years age group
A 2017 randomized clinical trial of ~900 patients showed no difference in clinical care, use of resources, or length of stay in hemodynamically stable children who received FAST + standard trauma evaluation versus standard trauma evaluation alone
There may be a role for FAST as a screening in patients with low suspicion for intraabdominal injury in conjunction with labs and physical exam, but this has not been fully explored
Bottom line: A positive FAST warrants further workup and may be helpful in the hemodynamically unstable pediatric trauma patient, but a negative FAST does not exclude intraabdominal injury and evidence for performing FAST in hemodynamically stable pediatric patients is limited.
References
Guyther, J. Advances in Pediatric Abdominal Trauma: What’s New is Assessment and Management. Trauma Reports 2016; 17: 1-15.
Holmes JF, Kelley KM, Wootton-Gorges SL, Utter GH, Abramson LP, Rose JS, Tancredi DJ, Kuppermann N. Effect of Abdominal Ultrasound on Clinical Care, Outcomes, and Resource Use Among Children With Blunt Torso Trauma: A Randomized Clinical Trial. JAMA. 2017 Jun 13;317(22):2290-2296.
