“We were surprised that the routine use of FAST did not show any significant differences,” said Nathan Kuppermann, professor and chair of emergency medicine at UC Davis and 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."

Length-of-stay times in the emergency department between the FAST group and the no-FAST group, for example, showed a minor differential of 6.03 hours versus 6.07 hours respectively. The difference in savings between hospital charges for patients in the FAST group and the no-FAST group was about $1,200 out of total charges of more than $46,000. There also was no significant difference in “missed” intra-abdominal injuries between the two groups.


WORKING TO LIMIT CT SCANS IN CHILDREN
Kuppermann and Holmes, who have led previous research studies designed to help emergency physicians safely avoid the use of CT scans for injured children, noted that even when an ultrasound gave physicians a better sense of the level of injury risk to a patient — and thus more confidence that serious injury risk was low — they still frequently ordered CT scans.

“In all of the cases where the risk was identified as ‘low’ [meaning the risk of serious intra-abdominal injury did not appear significant to the physician following the ultrasound], but where CT scans were ordered anyway, we didn’t find one patient who actually had an intra-abdominal injury,” added Kuppermann. “While ultrasound appears to have the potential to decrease CT use in children, we wanted to determine whether it actually worked in practice.”

LIMITATIONS OF STUDY
The researchers noted that the new study does have certain limitations and should be cautiously interpreted. It was conducted at only one site — UC Davis Medical Center — which the authors say might have specific patient-care practices that influenced the results so that they may not be generalizable to other hospitals.

The relatively small size of the trial, despite randomizing 925 patients, also may “not have been adequately powered to detect small differences in outcomes” between study groups or in important subsets of children, particularly the youngest ones who are most susceptible to the radiation risks of CT scans, according to the authors.

Given the findings of the current study, the authors suggest a large, multicenter randomized clinical trial would more definitively answer the question regarding the usefulness of the FAST examination in children after blunt torso trauma.

Ultrasound Homepage