Document Type
Article
Publication Date
6-2025
Identifier
DOI: 10.1002/jum.16661; PMCID: PMC12067152
Abstract
OBJECTIVES: To evaluate the reliability of physician gestalt estimation of pelvic free fluid volume on pediatric Focused Assessment with Sonography for Trauma (FAST). To determine a reliable cut-off volume and characteristics associated with small pelvic free fluid.
METHODS: Our study assessed the ability of 2 ultrasound-trained pediatric emergency medicine (PEM) physicians and 2 pediatric radiologists to characterize pelvic free fluid in a retrospective convenience sample of archived FAST from a Level 1 pediatric trauma center, April 2018-June 2020. Inter- and intra-rater reliability were measured to determine the most reliable volume cut-off. Chi-squared and Fisher's exact tests determined characteristics associated with physiologic fluid and fluid volume.
RESULTS: Eighty-one (10.2%) of 797 FAST had pelvic fluid and met inclusion criteria. Volume estimates using none/trace/small versus moderate/large classifications were moderately reliable by the PEM physicians (κ = 0.65 [95% CI, 0.63-0.66]; raw agreement = 92%) and radiologists (κ = 0.48 [95% CI, 0.47-0.49]; raw agreement = 91%). This volume cut-off demonstrated higher reliability for both groups and greater agreement for PEM physicians than none/trace versus small/moderate/large. Girls (P = .005), isoechoic (P = .045), and location posterior to bladder (P < .001) were associated with physiologic fluid and hyperechoic (P = .019) with non-physiologic fluid. Hyperechoic (P < .001), anterior (P < .001), lateral (P = .04), or "other" location (P < .001) relative to the bladder were associated with moderate/large volume.
CONCLUSIONS: Ultrasound-trained PEM physicians and pediatric radiologists can reliably use gestalt estimation to distinguish moderate or large fluid from smaller pelvic fluid volumes on pediatric FAST.
Journal Title
Journal of ultrasound in medicine : official journal of the American Institute of Ultrasound in Medicine
Volume
44
Issue
6
First Page
1017
Last Page
1025
MeSH Keywords
Humans; Reproducibility of Results; Female; Retrospective Studies; Child; Male; Pelvis; Focused Assessment with Sonography for Trauma; Child, Preschool; Adolescent; Ultrasonography; Infant; Clinical Competence
PubMed ID
39945112
Keywords
FAST; pediatric trauma; pelvic free fluid; reliability
Recommended Citation
Shaahinfar A, Wiebelhaus JR, Addo N, Cohen RA, Karakas-Rothey P, Kornblith AE. Reliability of Physician Estimation of Pelvic Free Fluid Volume on the Pediatric Focused Assessment With Sonography for Trauma. J Ultrasound Med. 2025;44(6):1017-1025. doi:10.1002/jum.16661
Comments
Grants and funding
This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made.
Publisher's Link: https://onlinelibrary.wiley.com/doi/10.1002/jum.16661