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Kornblith AE, Addo N, Plasencia M, Shaahinfar A, Lin-Martore M, Sabbineni N, Gold D, Bellman L, Berant R, Bergmann KR, Brenkert TE, Chen A, Constantine E, Deanehan JK, Dessie A, Elkhunovich M, Fischer J, Gravel CA, Kharasch S, Kwan CW, Lam SHF, Neal JT, Pade KH, Rempell R, Shefrin AE, Sivitz A, Snelling PJ, Tessaro MO, White W. Development of a Consensus-Based Definition of Focused Assessment With Sonography for Trauma in Children. JAMA Netw Open 2022; 5:e222922. [PMID: 35302632 PMCID: PMC8933745 DOI: 10.1001/jamanetworkopen.2022.2922] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2021] [Accepted: 01/30/2022] [Indexed: 11/14/2022] Open
Abstract
Importance The wide variation in the accuracy and reliability of the Focused Assessment With Sonography for Trauma (FAST) and the extended FAST (E-FAST) for children after blunt abdominal trauma reflects user expertise. FAST and E-FAST that are performed by experts tend to be more complete, better quality, and more often clinically valuable. Objective To develop definitions of a complete, high-quality, and accurate interpretation for the FAST and E-FAST in children with injury using an expert, consensus-based modified Delphi technique. Design, Setting, and Participants This consensus-based qualitative study was conducted between May 1 to June 30, 2021. It used a scoping review and iterative Delphi technique and involved 2 rounds of online surveys and a live webinar to achieve consensus among a 26-member panel. This panel consisted of international experts in pediatric emergency point-of-care ultrasonography. Main Outcomes and Measures Definitions of complete, high-quality, and accurate FAST and E-FAST studies for children after injury. Results Of the 29 invited pediatric FAST experts, 26 (15 men [58%]) agreed to participate in the panel. All 26 panelists completed the 2 rounds of surveys, and 24 (92%) participated in the live and asynchronous online discussions. Consensus was reached on FAST and E-FAST study definitions, and the panelists rated these 5 anatomic views as important and appropriate for a complete FAST: right upper-quadrant abdominal view, left upper-quadrant abdominal view, suprapubic views (transverse and sagittal), and subxiphoid cardiac view. For E-FAST, the same FAST anatomic views with the addition of the lung or pneumothorax view were deemed appropriate and important. In addition, the panelists rated a total of 32 landmarks as important for assessing completeness. Similarly, the panelists rated 14 statements on quality and 20 statements on accurate interpretation as appropriate. Conclusions and Relevance This qualitative study generated definitions for complete FAST and E-FAST studies with high image quality and accurate interpretation in children with injury. These definitions are similar to those in adults with injury and may be used for future education, quality assurance, and research. Future research may focus on interpretation of trace volumes of abdominal free fluid and the use of serial FAST.
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Affiliation(s)
- Aaron E. Kornblith
- Department of Pediatrics, University of California, San Francisco, San Francisco
- Department of Emergency Medicine, University of California, San Francisco, San Francisco
| | - Newton Addo
- Department of Emergency Medicine, University of California, San Francisco, San Francisco
- Department of Medicine, University of California, San Francisco, San Francisco
| | - Monica Plasencia
- Department of Bioengineering and Therapeutic Sciences, University of California, San Francisco, San Francisco
- Department of Bioengineering, University of California, Berkeley, Berkeley
| | - Ashkon Shaahinfar
- Department of Pediatrics, University of California, San Francisco, San Francisco
- Department of Emergency Medicine, University of California, San Francisco, San Francisco
| | - Margaret Lin-Martore
- Department of Pediatrics, University of California, San Francisco, San Francisco
- Department of Emergency Medicine, University of California, San Francisco, San Francisco
| | - Naina Sabbineni
- Department of Emergency Medicine, University of California, San Francisco, San Francisco
| | - Delia Gold
- Department of Pediatrics, Division of Emergency Medicine, Nationwide Children’s Hospital, Columbus, Ohio
| | - Lily Bellman
- Division of Pediatric Emergency Medicine, Department of Pediatric Emergency Medicine, Harbor-UCLA (University of California, Los Angeles) Medical Center, California Pacific Medical Center, Los Angeles
| | - Ron Berant
- Department of Emergency Medicine, Schneider Children’s Medical Center of Israel, Petah Tikva, Israel
| | - Kelly R. Bergmann
- Department of Pediatric Emergency Medicine, Children’s Minnesota, Minneapolis
| | - Timothy E. Brenkert
- Division of Pediatric Emergency Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
| | - Aaron Chen
- Division of Emergency Medicine, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Erika Constantine
- Division of Pediatric Emergency Medicine, Hasbro Children’s Hospital, Rhode Island Hospital, Providence
| | - J. Kate Deanehan
- Division of Pediatric Emergency Medicine, Johns Hopkins Children’s Center, Baltimore, Maryland
| | - Almaz Dessie
- Department of Emergency Medicine, Columbia University Vagelos College of Physicians and Surgeons, New York, New York
| | - Marsha Elkhunovich
- Division of Emergency and Transport Medicine, Children’s Hospital Los Angeles, Los Angeles, California
| | - Jason Fischer
- Division of Emergency Medicine, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Cynthia A. Gravel
- Division of Emergency Medicine, Boston Children’s Hospital, Boston, Massachusetts
| | - Sig Kharasch
- Department of Pediatrics, Massachusetts General Hospital, Boston
- Department of Emergency Medicine, Massachusetts General Hospital, Boston
| | - Charisse W. Kwan
- Department of Pediatric Emergency Medicine, London Health Sciences Centre Children's Hospital, Western University, London, Ontario, Canada
| | - Samuel H. F. Lam
- Department of Emergency Medicine, Sutter Medical Center Sacramento, Sacramento, California
| | - Jeffrey T. Neal
- Division of Emergency Medicine, Boston Children’s Hospital, Boston, Massachusetts
| | - Kathyrn H. Pade
- Department of Emergency Medicine, Rady Children’s Hospital, University of California, San Diego, San Diego
| | - Rachel Rempell
- Division of Emergency Medicine, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Allan E. Shefrin
- Department of Pediatrics, Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, Ontario, Canada
| | - Adam Sivitz
- Department of Pediatric Emergency Medicine, Children’s Hospital of New Jersey, Newark Beth Israel Medical Center, Newark
| | - Peter J. Snelling
- Department of Pediatric Emergency Medicine, Gold Coast University Hospital, Griffith University, Brisbane, Queensland, Australia
| | - Mark O. Tessaro
- Division of Emergency Medicine, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - William White
- Division of Pediatric Emergency Medicine, Department of Pediatric Emergency Medicine, Harbor-UCLA (University of California, Los Angeles) Medical Center, California Pacific Medical Center, Los Angeles
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Babl FE, Cooper ER, Kastner B, Kharasch S. Prophylaxis against possible human immunodeficiency virus exposure after nonoccupational needlestick injuries or sexual assaults in children and adolescents. Arch Pediatr Adolesc Med 2001; 155:680-2. [PMID: 11386957 DOI: 10.1001/archpedi.155.6.680] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
BACKGROUND Nonoccupational human immunodeficiency virus (HIV) postexposure prophylaxis (PEP) for adults has been described, although the Centers for Disease Control and Prevention, Atlanta, Ga, offer no specific recommendations. There is limited information about its use in children and adolescents. OBJECTIVE To describe the current practices of physicians in pediatric infectious disease (PID) and pediatric emergency medicine (PEM) departments regarding nonoccupational HIV PEP for children and adolescents. DESIGN Survey. PARTICIPANTS Directors of all PID and PEM departments with fellowship programs in the United States and Canada between July and November 1998. MAIN OUTCOME MEASURES General questions regarding HIV PEP and questions concerning 2 scenarios (5-year-old with a needlestick injury and a 15-year-old after sexual assault). RESULTS The return rate was 67 (78%) of 86 for PID and 36 (75%) of 48 for PEM physicians. Fewer than 20% of physicians reported institutional policies for nonoccupational HIV PEP; 33% had ever initiated nonoccupational HIV PEP. In both scenarios, PID physicians were more likely than PEM physicians to recommend or offer HIV PEP in the first 24 hours after the incident (55 [83%] of 66 vs 20 [56%] of 36 for needlestick injuries [odds ratio, 4.0; 95% confidence interval, 1.6-10.1] and 47 [72%] of 65 vs 16 [50%] of 32 for sexual assault [odds ratio, 2.6; 95% confidence interval, 1.1-6.3]). Seven different antiretroviral agents in single, dual, or triple drug regimens administered for 2 to 12 weeks were suggested. CONCLUSIONS Although few physicians reported institutional policies, and only one third had ever initiated HIV PEP, many would offer or recommend HIV PEP for children and adolescents within 24 hours after possible HIV exposure. A wide variation of regimens have been suggested. There is a need for a national consensus for nonoccupational HIV PEP.
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Affiliation(s)
- F E Babl
- Division of Pediatric Infectious Diseases, Finland 5, Boston Medical Center, 1 Boston Medical Center Place, Boston, MA 02118, USA.
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Abstract
HIV postexposure prophylaxis (PEP) is now a well-established part of the management of health care workers after occupational exposures to HIV. Use of PEP for adults exposed to HIV after sexual contact or injection drug use in nonoccupational settings remains controversial with limited data available. There is even less information available concerning HIV PEP for children and adolescents after accidental needlestick injuries or sexual assault. The objective was to describe the current practice of and associated problems with HIV PEP for children and adolescents at an urban academic pediatric emergency department. A retrospective review of all children and adolescents offered HIV PEP between June 1997-June 1998 was conducted. Ten pediatric and adolescent patients were offered HIV PEP, six patients after sexual assault, four patients after needle stick injuries. There were two small children 2 and 3 years of age and eight adolescents. Of these 10 patients, eight were started on HIV PEP. The regimens used for PEP varied; zidovudine, lamivudine, and indinavir were prescribed for in seven patients and zidovudine, lamivudine, and nelfinavir for one other. All 10 patients were HIV negative by serology at baseline testing and all available for follow-up testing (5 of 10) remained HIV negative at 4 to 28 weeks. Only two patients completed the full course of 4 weeks of antiretroviral therapy. Financial concerns, side effects, additional psychiatric and substance abuse issues as well as the degree of parental involvement influenced whether PEP and clinical follow-up was completed. HIV PEP in the nonoccupational setting for children and adolescents presents a medical and management challenge, and requires a coordinated effort at the initial presentation to the health care system and at follow-up. The difficulties encountered in the patients in our series need to be considered before initiating prophylaxis. A provisional management approach to HIV PEP in children and adolescents is proposed.
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Affiliation(s)
- F E Babl
- Division of Pediatric Emergency Medicine, Boston University School of Medicine, Boston Medical Center, MA 02118, USA.
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