Negative focused abdominal sonography for trauma examination predicts successful nonoperative management in pediatric solid organ injury: A prospective Arizona-Texas-Oklahoma-Memphis-Arkansas + Consortium study

Paul McGaha, Prasenjeet Motghare, Zoona Sarwar, Nilda M. Garcia, Karla A. Lawson, Amina Bhatia, Crystal S. Langlais, Maria E. Linnaus, R. Todd Maxson, James W. Eubanks, Adam C. Alder, David Tuggle, Todd A. Ponsky, Charles W. Leys, Daniel J. Ostlie, Shawn D. St Peter, David M. Notrica, Robert W. Letton

Research output: Contribution to journalArticle

Abstract

BACKGROUND Focused Abdominal Sonography for Trauma (FAST) examination has long been proven useful in the management of adult trauma patients, however, its utility in pediatric trauma patients is not as proven. Our goal was to evaluate the utility of a FAST examination in predicting the success or failure of nonoperative management (NOM) of blunt liver and/or spleen (BLSI) in the pediatric trauma population. METHODS A retrospective analysis of a prospective observational study of patients younger than 18 years presenting with BLSI to one of ten Level I pediatric trauma centers between April 2013 and January 2016. 1,008 patients were enrolled and 292 had a FAST examination recorded. We analyzed failure of NOM of BLSI in the pediatric trauma population. We then compared FAST examination alone or in combination with the pediatric age adjusted shock index (SIPA) as it relates to success of NOM of BLSI. RESULTS Focused Abdominal Sonography for Trauma examination had a negative predictive value (NPV) of 97% and positive predictive value (PPV) of 13%. The odds ratio of failing with a positive FAST examination was 4.9 and with a negative FAST was 0.20. When combined with SIPA, a positive FAST examination and SIPA had a PPV of 17%, and an odds ratio for failure of 4.9. The combination of negative FAST and SIPA had an NPV of 96%, and the odds ratio for failure was 0.20. CONCLUSION Negative FAST is predictive of successful NOM of BLSI. The addition of a positive or negative SIPA score did not affect the PPV or NPV significantly. Focused Abdominal Sonography for Trauma examination may be useful clinically in determining which patients are not at risk for failure of NOM of BLSI and do not require monitoring in an intensive care setting.

Original languageEnglish (US)
Pages (from-to)86-91
Number of pages6
JournalJournal of Trauma and Acute Care Surgery
Volume86
Issue number1
DOIs
StatePublished - Jan 1 2019

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Ultrasonography
Pediatrics
Wounds and Injuries
Odds Ratio
Trauma Centers
Critical Care
Population
Observational Studies
Shock
Spleen
Prospective Studies

Keywords

  • FAST
  • Pediatric trauma
  • SIPA
  • blunt liver and spleen injury
  • nonoperative management

ASJC Scopus subject areas

  • Surgery
  • Critical Care and Intensive Care Medicine

Cite this

Negative focused abdominal sonography for trauma examination predicts successful nonoperative management in pediatric solid organ injury : A prospective Arizona-Texas-Oklahoma-Memphis-Arkansas + Consortium study. / McGaha, Paul; Motghare, Prasenjeet; Sarwar, Zoona; Garcia, Nilda M.; Lawson, Karla A.; Bhatia, Amina; Langlais, Crystal S.; Linnaus, Maria E.; Maxson, R. Todd; Eubanks, James W.; Alder, Adam C.; Tuggle, David; Ponsky, Todd A.; Leys, Charles W.; Ostlie, Daniel J.; St Peter, Shawn D.; Notrica, David M.; Letton, Robert W.

In: Journal of Trauma and Acute Care Surgery, Vol. 86, No. 1, 01.01.2019, p. 86-91.

Research output: Contribution to journalArticle

McGaha, P, Motghare, P, Sarwar, Z, Garcia, NM, Lawson, KA, Bhatia, A, Langlais, CS, Linnaus, ME, Maxson, RT, Eubanks, JW, Alder, AC, Tuggle, D, Ponsky, TA, Leys, CW, Ostlie, DJ, St Peter, SD, Notrica, DM & Letton, RW 2019, 'Negative focused abdominal sonography for trauma examination predicts successful nonoperative management in pediatric solid organ injury: A prospective Arizona-Texas-Oklahoma-Memphis-Arkansas + Consortium study', Journal of Trauma and Acute Care Surgery, vol. 86, no. 1, pp. 86-91. https://doi.org/10.1097/TA.0000000000002074
McGaha, Paul ; Motghare, Prasenjeet ; Sarwar, Zoona ; Garcia, Nilda M. ; Lawson, Karla A. ; Bhatia, Amina ; Langlais, Crystal S. ; Linnaus, Maria E. ; Maxson, R. Todd ; Eubanks, James W. ; Alder, Adam C. ; Tuggle, David ; Ponsky, Todd A. ; Leys, Charles W. ; Ostlie, Daniel J. ; St Peter, Shawn D. ; Notrica, David M. ; Letton, Robert W. / Negative focused abdominal sonography for trauma examination predicts successful nonoperative management in pediatric solid organ injury : A prospective Arizona-Texas-Oklahoma-Memphis-Arkansas + Consortium study. In: Journal of Trauma and Acute Care Surgery. 2019 ; Vol. 86, No. 1. pp. 86-91.
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abstract = "BACKGROUND Focused Abdominal Sonography for Trauma (FAST) examination has long been proven useful in the management of adult trauma patients, however, its utility in pediatric trauma patients is not as proven. Our goal was to evaluate the utility of a FAST examination in predicting the success or failure of nonoperative management (NOM) of blunt liver and/or spleen (BLSI) in the pediatric trauma population. METHODS A retrospective analysis of a prospective observational study of patients younger than 18 years presenting with BLSI to one of ten Level I pediatric trauma centers between April 2013 and January 2016. 1,008 patients were enrolled and 292 had a FAST examination recorded. We analyzed failure of NOM of BLSI in the pediatric trauma population. We then compared FAST examination alone or in combination with the pediatric age adjusted shock index (SIPA) as it relates to success of NOM of BLSI. RESULTS Focused Abdominal Sonography for Trauma examination had a negative predictive value (NPV) of 97{\%} and positive predictive value (PPV) of 13{\%}. The odds ratio of failing with a positive FAST examination was 4.9 and with a negative FAST was 0.20. When combined with SIPA, a positive FAST examination and SIPA had a PPV of 17{\%}, and an odds ratio for failure of 4.9. The combination of negative FAST and SIPA had an NPV of 96{\%}, and the odds ratio for failure was 0.20. CONCLUSION Negative FAST is predictive of successful NOM of BLSI. The addition of a positive or negative SIPA score did not affect the PPV or NPV significantly. Focused Abdominal Sonography for Trauma examination may be useful clinically in determining which patients are not at risk for failure of NOM of BLSI and do not require monitoring in an intensive care setting.",
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author = "Paul McGaha and Prasenjeet Motghare and Zoona Sarwar and Garcia, {Nilda M.} and Lawson, {Karla A.} and Amina Bhatia and Langlais, {Crystal S.} and Linnaus, {Maria E.} and Maxson, {R. Todd} and Eubanks, {James W.} and Alder, {Adam C.} and David Tuggle and Ponsky, {Todd A.} and Leys, {Charles W.} and Ostlie, {Daniel J.} and {St Peter}, {Shawn D.} and Notrica, {David M.} and Letton, {Robert W.}",
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T1 - Negative focused abdominal sonography for trauma examination predicts successful nonoperative management in pediatric solid organ injury

T2 - A prospective Arizona-Texas-Oklahoma-Memphis-Arkansas + Consortium study

AU - McGaha, Paul

AU - Motghare, Prasenjeet

AU - Sarwar, Zoona

AU - Garcia, Nilda M.

AU - Lawson, Karla A.

AU - Bhatia, Amina

AU - Langlais, Crystal S.

AU - Linnaus, Maria E.

AU - Maxson, R. Todd

AU - Eubanks, James W.

AU - Alder, Adam C.

AU - Tuggle, David

AU - Ponsky, Todd A.

AU - Leys, Charles W.

AU - Ostlie, Daniel J.

AU - St Peter, Shawn D.

AU - Notrica, David M.

AU - Letton, Robert W.

PY - 2019/1/1

Y1 - 2019/1/1

N2 - BACKGROUND Focused Abdominal Sonography for Trauma (FAST) examination has long been proven useful in the management of adult trauma patients, however, its utility in pediatric trauma patients is not as proven. Our goal was to evaluate the utility of a FAST examination in predicting the success or failure of nonoperative management (NOM) of blunt liver and/or spleen (BLSI) in the pediatric trauma population. METHODS A retrospective analysis of a prospective observational study of patients younger than 18 years presenting with BLSI to one of ten Level I pediatric trauma centers between April 2013 and January 2016. 1,008 patients were enrolled and 292 had a FAST examination recorded. We analyzed failure of NOM of BLSI in the pediatric trauma population. We then compared FAST examination alone or in combination with the pediatric age adjusted shock index (SIPA) as it relates to success of NOM of BLSI. RESULTS Focused Abdominal Sonography for Trauma examination had a negative predictive value (NPV) of 97% and positive predictive value (PPV) of 13%. The odds ratio of failing with a positive FAST examination was 4.9 and with a negative FAST was 0.20. When combined with SIPA, a positive FAST examination and SIPA had a PPV of 17%, and an odds ratio for failure of 4.9. The combination of negative FAST and SIPA had an NPV of 96%, and the odds ratio for failure was 0.20. CONCLUSION Negative FAST is predictive of successful NOM of BLSI. The addition of a positive or negative SIPA score did not affect the PPV or NPV significantly. Focused Abdominal Sonography for Trauma examination may be useful clinically in determining which patients are not at risk for failure of NOM of BLSI and do not require monitoring in an intensive care setting.

AB - BACKGROUND Focused Abdominal Sonography for Trauma (FAST) examination has long been proven useful in the management of adult trauma patients, however, its utility in pediatric trauma patients is not as proven. Our goal was to evaluate the utility of a FAST examination in predicting the success or failure of nonoperative management (NOM) of blunt liver and/or spleen (BLSI) in the pediatric trauma population. METHODS A retrospective analysis of a prospective observational study of patients younger than 18 years presenting with BLSI to one of ten Level I pediatric trauma centers between April 2013 and January 2016. 1,008 patients were enrolled and 292 had a FAST examination recorded. We analyzed failure of NOM of BLSI in the pediatric trauma population. We then compared FAST examination alone or in combination with the pediatric age adjusted shock index (SIPA) as it relates to success of NOM of BLSI. RESULTS Focused Abdominal Sonography for Trauma examination had a negative predictive value (NPV) of 97% and positive predictive value (PPV) of 13%. The odds ratio of failing with a positive FAST examination was 4.9 and with a negative FAST was 0.20. When combined with SIPA, a positive FAST examination and SIPA had a PPV of 17%, and an odds ratio for failure of 4.9. The combination of negative FAST and SIPA had an NPV of 96%, and the odds ratio for failure was 0.20. CONCLUSION Negative FAST is predictive of successful NOM of BLSI. The addition of a positive or negative SIPA score did not affect the PPV or NPV significantly. Focused Abdominal Sonography for Trauma examination may be useful clinically in determining which patients are not at risk for failure of NOM of BLSI and do not require monitoring in an intensive care setting.

KW - FAST

KW - Pediatric trauma

KW - SIPA

KW - blunt liver and spleen injury

KW - nonoperative management

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