A Randomized Controlled Trial of Abdominal Ultrasound (FAST) in Children with Blunt Torso Trauma

Hypothesis We hypothesize that in children: 1. An ED evaluation strategy incorporating the FAST examination will result in at least a 5-percentage point decrease in the frequency of CT scan use compared to the non-FAST study arm. 2. An evaluation strategy which includes the FAST examination will show no difference in frequency of missed IAIs compared to the non-FAST study arm. 3. Several factors, including modifiable factors, are associated with obtaining CT scans in very low risk patients (clinician suspicion of <1% risk of IAI) following a negative FAST examination. 1.2 Specific Aims Specific Aim 1. To perform a RCT of the FAST examination in injured children during emergency department (ED) evaluation and compare the frequency of abdominal CT scanning between children in the FAST and non-FAST arms. Significance: Decreased CT use will increase patient safety by reducing the risks of radiation-induced malignancies. Specific Aim 2. To identify if an ED evaluation strategy including the FAST examination results in a similar frequency of missed or delayed diagnoses of IAIs than a strategy without the FAST examination. Significance: Physician acceptance of an evaluation strategy using the FAST examination will likely depend on that strategy not missing patients with IAIs. Specific Aim 3. To identify patient, physician, and system factors associated with obtaining CT scans in patients considered low risk for IAI by the clinician after a negative FAST examination. Significance: Identification of modifiable factors would assist in the design of implementation trials aimed at modifying physician behavior to appropriately use FAST examinations when evaluating injured children.