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TABLE 103.1
INDICATIONS FOR ABDOMINAL COMPUTED TOMOGRAPHIC
SCAN IN PEDIATRIC TRAUMA PATIENTS
1. Mechanism of injury suggesting abdominal trauma
2. Significant abdominal tenderness (the most predictive sign for intraabdominal injury)
3. Handlebar or seat belt ecchymosis
4. Slowly declining hematocrit
5. Unaccountable fluid or blood requirements
6. Neurologic injury precluding accurate abdominal examination
7. Hematuria
8. Acute “need to know” (e.g., before general anesthesia)

FOCUSED ABDOMINAL SONOGRAPHY FOR TRAUMA
Goals of Treatment
FAST is typically performed in the ED during the secondary survey. The operator
looks at four windows in the abdomen: the left upper quadrant, the right upper
quadrant, the pericardium via a subxiphoid window, and the pelvis. The purpose
of the scan is to detect free fluid. Free fluid in any of these areas indicates the
need for further evaluation and treatment.
The utility of FAST in the management of pediatric patients remains
controversial. The literature for pediatric patients with intra-abdominal injuries
suggests that FAST is not sufficiently sensitive and CT scanning remains the gold
standard for the radiologic evaluation in children. Since the mere presence of free
fluid within the abdomen is not an indication for operative intervention in
hemodynamically stable children, a positive FAST merits additional imaging. On
the other hand, a negative FAST does not exclude significant intra-abdominal
injury. Nonetheless, there is a role for FAST in pediatric populations, particularly
in unstable children or children who need immediate transfer to the operating
suite for an emergent procedure, such as cranial decompression. Although a
negative FAST finding does not exclude injury, a positive FAST finding is
evident enough to warrant exploration of the abdomen, either with laparoscopy or

with laparotomy, in such a patient (see Chapter 131 Ultrasound ).
CLINICAL PEARLS AND PITFALLS