Consensus definitions for assessing children with injury via sonography could help in the emergency department, according to research published March 18 in JAMA Network Open.
A team led by Dr. Aaron Kornblith from the University of California in San Francisco surveyed point-of-care ultrasonography (POCUS) experts and wrote a consensus statement on defining Focused Assessment with Sonography for Trauma (FAST) and extended FAST (E-FAST) studies. The recommendation includes ultrasonographic views, landmarks, and patient-specific factors that affect interpretation accuracy.
"Our definitions were developed using a rigorous methodology that included reviewing existing literature and expert consensus," Kornblith told AuntMinnie.com. "As a result, our definition is novel in that it captures the most critical views, landmarks, and accuracy consideration of experts for FAST in children."
FAST was introduced in the 1990s in the U.S. It uses ultrasonographic views to rapidly evaluate hemorrhaging in patients. In adults, this method decreases time to surgery, length of stay, complications, and CT scan rates. It does not require radiation. However, FAST has up and down reliability and accuracy compared with CT when identifying abdominal injuries in children. Additionally, there is no agreed-on standard for a complete protocol, image quality, and accurate interpretation for this method in pediatric patients.
"However, literature has shown that experts [instead of less experienced sonographers] perform the FAST more reliably and accurately than non-experts," Kornblith told AuntMinnie.com.
Kornblith and colleagues wanted to help with this by surveying ultrasonographers in defining a complete, high-quality, and accurate interpretation for FAST and E-FAST in children with injury using a modified Delphi technique.
Using data from 26 experts who completed the survey, including 24 who participated in online discussions, the team wrote that five anatomical views are important and appropriate for a complete FAST. These include the following:
- Right upper-quadrant abdominal view
- Left upper-quadrant abdominal view
- Suprapubic views (transverse and sagittal)
- Subxiphoid cardiac view
The same anatomic views can be used for E-FAST with the addition of the lung or pneumothorax view, the survey participants indicated.
Respondents also rated a total of 32 landmarks as important for assessing completeness and rated 14 statements on quality, as well as 20 statements on accurate interpretation as appropriate.
However, two statements divided experts though in two nearly equal groups. These include: "A FAST study can be considered a qualified negative if the operator does not adequately visualize one or more landmarks," and "Trace free fluid in the pelvis may be considered a negative study."
They also suggested that reporting FAST and E-FAST results should include any missing view or landmarks in interpretations as well as patient factors that could limit exams.
Kornblith and colleagues called for future studies to focus on whether certain landmarks are more critical to view than others for a complete FAST, as well as assess the accuracy and reliability of the FAST and E-FAST methods by defining trace-free fluid.
"The consensus statements may be used for future education, quality assurance, and research," they wrote. "An agreement was reached on the potential use of serial FAST studies; however, the panelists were unclear on how to clinically interpret trace volumes of abdominal free fluid, suggesting a direction for future research."
![Examples of ultrasound findings and techniques. (A) Images in a 39-year-old male patient with a mass in the left thigh. The mass is heterogeneous on the B-mode US image (compared with the patient in D) and showed increased microvascularity (superb microvascular imaging [SMI]) and shear-wave elastography (SWE) values. Undifferentiated pleomorphic sarcoma was diagnosed at biopsy (with pleomorphic rhabdomyosarcoma in surgical specimen). (B) Images in an 18-year-old male patient with a mass in the left leg. The mass is hypoechoic on the B-mode image, with no other findings suggestive of malignancy. The lesion is in contact with the cortex of the tibia, which is slightly irregular. CT revealed a doubtful anteromedial tibial erosion. The microvascular study demonstrated high vascularization, suggestive of malignancy. Periosteal Ewing sarcoma was diagnosed with both histologic and immunohistochemical confirmation. (C) Images in a 69-year-old female patient with a lump growing on the outside of the left leg. Multiple SWE examinations were performed (please note the high values obtained in the measurements, whereas the color map highlights the stiffness relative to adjacent tissues). SMI showed areas of increased vascularization to target for sampling. Undifferentiated spindle cell sarcoma was diagnosed at biopsy, with residual leiomyosarcoma in the surgical specimen after neoadjuvant therapy. (D) Images in a 56-year-old female patient with a mass in the right thigh. The mass is heterogeneous at both B-mode ultrasound (similar to patient A) and MRI (coronal T2-weighted spectral attenuated inversion recovery [SPAIR]; T1-weighted pre-contrast and postcontrast imaging), which even shows uptake after the administration of paramagnetic contrast material, which is traditionally suggestive of malignancy. Low values at SMI and elastography are suggestive of benignity. Spindle cell lipoma was diagnosed at biopsy, with atypical spindle cell lipomatous tumor in the surgical specimen.](https://img.auntminnie.com/mindful/smg/workspaces/default/uploads/2026/08/images-radiol250278fig2.APCFLSvX6p.jpg?auto=format%2Ccompress&fit=crop&h=100&q=70&w=100)
![Examples of ultrasound findings and techniques. (A) Images in a 39-year-old male patient with a mass in the left thigh. The mass is heterogeneous on the B-mode US image (compared with the patient in D) and showed increased microvascularity (superb microvascular imaging [SMI]) and shear-wave elastography (SWE) values. Undifferentiated pleomorphic sarcoma was diagnosed at biopsy (with pleomorphic rhabdomyosarcoma in surgical specimen). (B) Images in an 18-year-old male patient with a mass in the left leg. The mass is hypoechoic on the B-mode image, with no other findings suggestive of malignancy. The lesion is in contact with the cortex of the tibia, which is slightly irregular. CT revealed a doubtful anteromedial tibial erosion. The microvascular study demonstrated high vascularization, suggestive of malignancy. Periosteal Ewing sarcoma was diagnosed with both histologic and immunohistochemical confirmation. (C) Images in a 69-year-old female patient with a lump growing on the outside of the left leg. Multiple SWE examinations were performed (please note the high values obtained in the measurements, whereas the color map highlights the stiffness relative to adjacent tissues). SMI showed areas of increased vascularization to target for sampling. Undifferentiated spindle cell sarcoma was diagnosed at biopsy, with residual leiomyosarcoma in the surgical specimen after neoadjuvant therapy. (D) Images in a 56-year-old female patient with a mass in the right thigh. The mass is heterogeneous at both B-mode ultrasound (similar to patient A) and MRI (coronal T2-weighted spectral attenuated inversion recovery [SPAIR]; T1-weighted pre-contrast and postcontrast imaging), which even shows uptake after the administration of paramagnetic contrast material, which is traditionally suggestive of malignancy. Low values at SMI and elastography are suggestive of benignity. Spindle cell lipoma was diagnosed at biopsy, with atypical spindle cell lipomatous tumor in the surgical specimen.](https://img.auntminnie.com/mindful/smg/workspaces/default/uploads/2026/08/images-radiol250278fig2.APCFLSvX6p.jpg?auto=format%2Ccompress&dpr=2&fit=crop&h=167&q=70&w=250)
