الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
Trauma is a leading cause of morbidity and mortality in childhood. The abdomen is the second most common site of injury. The most common reported mechanism for abdominal injury is motor vehicle crashes.
Any trauma patient should be managed according to ATLS guidelines and stabilization of the patient general condition should be the first priority. Abdominal examination, laboratory investigations and imageings are the methods of diagnosis and decision making.
FAST has become part of the initial trauma management, replacing diagnostic peritoneal lavage. It is rapid, bedside tool that can be done in the primary survey and resuscitation.
CT is the imaging method of choice in the evaluation of BAT in hemodynamically stable patient. IV and oral contrast and sedation may be needed. CT primarily guides non operative decisions such as the duration of hospitalization, intensity of care, and length of activity restriction.
This prospective study was conducted on all patients with blunt abdominal trauma who were admitted to Alexandria main university hospital through the Emergency Room from 1st of May 2013 to 30th of October 2013.
The aim of this study is to determine the Assess feasibility and accuracy of FAST and Computerized Tomography (CT) in the emergency department (ED) as screening for the detection of intra-abdominal injuries in pediatric patients with BAT.
During the study period 150 patients below the age of 18 years with blunt abdominal trauma with 109 males, 41 females with a median age of 9 years (range 3 days -17 years). 54% had Road traffic Accident (RTA), 39.3% reported fall from height (FFH). 73 (48.7%) children did not show hemoperitoneum upon FAST and 1 patient with minimal collection. Of them 68 (45.3%) cases were discharged home immediately after primary survey. Positive cases with FAST had hemoperitoneum that was minimal in 53 (68.8%), mild 19 (24.7%), and moderate in 5 (6.5%) cases. 50 patients were conserved. 15 patients were operated (12 had mild or moderate collection upon FAST), and 6 cases died. FAST findings were significantly related to the grade of shock (95% confidence interval [CI], P<.001). FAST showed 95.2% sensitivity, 95.12% specificity, 100% positive predictive value, and 0% negative predictive value (95% CI). 38 patients underwent contrast CT. Significant relations were found between FAST and CT as regards the mean examination time (11.29 vs. 54.72 minutes) (95% CI, P<.001), detection of grade of fluid collection (95% CI, P=.004) The Spleen was the most common injured organ in children in both investigation tools where in FAST 18 (23.4%) cases versus 16 (39%) cases with CT (95% CI, P=.002), followed by the liver; 14 (18.2%) cases detected by FAST versus 14 (34.1%) cases by CT (95% CI, P=.05).
Our data favors FAST as a rapid, sensitive, safe, bed side and cost effective screening and follow up tool for free fluid in children with BAT. CT scan is a secondary measure that is used in selected cases for grading of organ injuries shows higher cost, time consumption and require more facilities in the crowded ED.