Do stable patients with a negative FAST exam need a CT of the abdomen and pelvis?
The answer may be No! In a recent study by Pershad et al., stable patients without peritoneal signs were followed by serial FAST exams and hematocrits. This approach resulted in 57% less CT scans and no adverse patient outcomes. In addition, most pediatric patients experiencing abdominal organ injury will stabilize after initial resuscitation and be managed non-operatively. This fact begs the question of doing CT exams if the FAST exam is positive and the patient is otherwise stable and does not have peritoneal findings. Therefore, the potential for using only the FAST exam for specific cases of pediatric abdominal trauma is possible. Another benefit of the FAST exam is rapid detection of hemothorax. If found, preparation for tube thoracostomy can be made prior to obtaining a chest radiograph. The echocardiography is performed in conjunction with the FAST exam. All patients with penetrating chest trauma should have a bedside echocardiogram done as part of their initial evaluation. Earl
