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While ultrasound screening (FAST) of the abdomen has been routinely
utilized in adult trauma patients for many years with excellent sensitivity
and specificity, the utility of FAST in children is a source of much
debate.
Review of several studies of adults with blunt abdominal trauma
suggests that the immediate use of FAST may reduce the use of CT for
unstable patients with a positive ultrasound finding. The preponderance
of recent literature suggests that FAST (in unstable patients) may
support a decision to proceed to laparotomy without the need to
undergo further testing (diagnostic therapeutic lavage or CT).
In the unstable patient, free fluid points toward the need for operative
intervention, whereas in the stable patient, further evaluation with CT
scan is indicated.

DIAGNOSTIC IMAGING FOR ABDOMINAL TRAUMA
Goals of Treatment
Radiographic evaluation of children with abdominal trauma may include plain
radiographs, contrast studies, ultrasound, and CT. CT scanning of the abdomen
after blunt trauma is the standard of care when suspicion of intra-abdominal
injury exists. Intravenous contrast is recommended to obtain the greatest amount
of information from a single study. Importantly, not all trauma surgeons or
radiologists agree that oral contrast is required for all cases, especially if time is
limited. If a nasogastric or orogastric tube is in place, it should be withdrawn
temporarily into the esophagus to avoid an artifact from its radiopaque marker.
Although CT is the most common technique used in childhood trauma, the
surgeon’s decision to proceed to laparotomy or laparoscopy may be based more
on the clinical status of the child than on the radiologic findings. Abdominal CT
is considered the most sensitive diagnostic tool, although FAST may provide
important data early in the course of the management of a child with suspected
intra-abdominal injuries ( Fig. 103.2 ).