Objective. To assess the diagnostic value and clinical effectiveness of the FAST protocol in children with blunt solid-organ injuries (BSOI) compared with conventional ultrasonography.

Materials and Methods. This single-center cohort study analyzed 117 children with hepatic and/or splenic injuries treated at the Republican Research Center of Emergency Medicine (RRCEM), Tashkent, during 2006–2024. Two cohorts were compared: a comparison group (2006–2017; n=61) evaluated with non-contrast ultrasonography, and a FAST group (2017–2024; n=56) in which FAST was integrated into the diagnostic pathway. Assessed variables included AAST injury grade, volume of free intraperitoneal fluid, hemodynamic status, diagnostic sensitivity and specificity, treatment strategy, and clinical outcomes. Statistical analysis used the χ² test and Student’s t-test; p<0.05 was considered significant.

Results. FAST demonstrated high diagnostic performance – sensitivity 83.9% and specificity 96.4% – significantly exceeding that of conventional ultrasonography (68.8% and 75.0%, respectively; p<0.01). In the FAST cohort, the rates of laparotomy (32.1% vs 60.7%; p=0.004), conversion from laparoscopy to laparotomy (32.0% vs 66.7%; p=0.033), and overall open procedures (46.4% vs 86.9%; p<0.001) were all significantly lower. Conservative management was feasible in 23.2% of patients versus 0% in the comparison cohort; all conservatively treated children were discharged in satisfactory condition. Mean length of stay was 4.5±2.3 days in conservatively managed patients.

Conclusion. Incorporation of FAST into the evaluation of pediatric BSOI substantially improved diagnostic accuracy, optimized surgical decision-making, reduced unnecessary laparotomies, and expanded organ-preserving conservative care. FAST should be regarded as an essential component of the diagnostic algorithm for pediatric hepatic and splenic trauma.

Children, blunt abdominal trauma, FAST protocol

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