False-Positive Focused Assessment with Sonography in Trauma (FAST) Exam in a Pediatric Trauma Patient Highlights Concerns for the Operational Environment: A Case Report

Maya Alexandri*, Alyssa K Soules, Cameron S Wolterstorff, Christopher A Mitchell, Guyon J Hill, Eric Dodson, Joseph Rangel, William Harvey, Chelsea E Ausman and Dan Brillhart

Introduction: The Focused Assessment with Sonography in Trauma (FAST) ultrasound exam is a critical tool used by medical providers in deployed settings to identify life-threating injuries and inform triage decisions. Its application to pediatric patients, however, remains underexplored and faces obstacles in austere, combat environments. Diagnostic inaccuracies using FAST in this context may result in unnecessary evacuations or missed injuries, straining battlefield resources and operational priorities. 

Case presentation: A six-month old female presented to a military treatment facility Emergency Department after a blunt trauma injury and received a FAST exam that was interpreted as positive for intraperitoneal free fluid. Her AST was mildly elevated at 67. Subsequent CT scan of the abdomen was negative for intrabdominal injury.

Discussion: Pediatric FAST exams present unique questions which have not been considered adequately in the military medical literature. Although the FAST exam is not intended to be used in isolation, deployed medical providers have limited access to ancillary testing that could otherwise inform interpretation of a pediatric FAST exam. The relative rarity of pediatric trauma in the deployed environment heightens the risk of false positives and negatives. As demonstrated by the case presentation, even with ancillary testing and an experienced operator, the FAST exam in pediatric patients can yield false positives that could strain scarce resources in austere settings. 

Conclusion: With respect to the FAST exam in pediatric trauma patients, an urgent need exists for additional research, robust training, and a JTS CPG.

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Published on: Nov 25, 2025 Pages: 27-31

Full Text PDF Full Text HTML DOI: 10.17352/ojt.000050
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