Ultrasound versus computed tomography scan findings in pediatric blunt abdominal traumas
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Abstract
Objective: We aimed to evaluate the performance of ultrasonography (US) versus computed tomography (CT) scan in detecting intra-abdominal injury among pediatric patients with blunt abdominal trauma. Methods: Pediatric patients aged<18, who were admitted to the emergency department (ED) due to abdominal trauma and underwent both US and CT scan were evaluated retrospectively. Results: A total of 732 pediatric patients were included in this study. Pathology was detected on US of 418 (57.1%) cases, whereas, intra-abdominal pathology was detected in CT scan of 359 (48.7%) cases. The sensitivity of US in detecting pathology (fluid and/or organ injury) was 95.3%, and its specificity was 79.6%. The sensitivity of US in detecting free fluid was 94.9%, and its specificity was 80.5%. In patients with unstable and stable hemodynamic, the sensitivities of US in detection of pathology (fluid and/or organ injury) were 97.6% and 91.6%, and its specificities were 74.3% and 80.9%, respectively. Conclusions: In our study, the sensitivity of US in terms of detecting pathology in pediatrics with blunt abdominal trauma was high, whereas the specificity of US was low.
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4. Liang T, Roseman E, Gao M, Sinert R. The utility of the focused assessment with sonography in trauma examination in pediatric blunt abdominal trauma: a systematic review and meta-analysis. Pediatr Emerg Care. 2021;37(2):108-18.
5. McGaha Pn, Motghare P, Sarwar Z, et al. Negative Focused Abdominal Sonography for Trauma examination predicts successful nonoperative management in pediatric solid organ injury: A prospective Arizona-Texas-Oklahoma-Memphis-Arkansas+ Consortium study. J Trauma Acute Care Surg. 2019;86(1):86-91.
6. Holmes JF, Lillis K, Monroe D, et al. Identifying children at very low risk of clinically important blunt abdominal injuries. Ann Emerg Med. 2013;62(2):107-16.e2.
7. Retzlaff T, Hirsch W, Till H, Rolle U. Is sonography reliable for the diagnosis of pediatric blunt abdominal trauma? J Pediatr Surg. 2010;45(5):912-5.
8. Kim PK, Zhu X, Houseknecht E, Nickolaus D, Mahboubi S, Nance ML. Effective radiation dose from radiologic studies in pediatric trauma patients. World J Surg. 2005;29(12):1557-62.
9. Tien HC, Tremblay LN, Rizoli SB, et al. Radiation exposure from diagnostic imaging in severely injured trauma patients. J Trauma Acute Care Surg. 2007;62(1):151-6.
10. Rice HE, Frush DP, Farmer D, Waldhausen JH, Committee AE. Review of radiation risks from computed tomography: essentials for the pediatric surgeon. J Pediatr Surg. 2007;42(4):603-7.
11. Holmes JF, Gladman A, Chang CH. Performance of abdominal ultrasonography in pediatric blunt trauma patients: a meta-analysis. J Pediatr Surg. 2007;42(9):1588-94.
12. Coley BD, Mutabagani KH, Martin LC, et al. Focused abdominal sonography for trauma (FAST) in children with blunt abdominal trauma. J Trauma Acute Care Surg. 2000;48(5):902-6.
13. Emery KH, McAneney CM, Racadio JM, Johnson ND, Evora DK, Garcia VF. Absent peritoneal fluid on screening trauma ultrasonography in children: a prospective comparison with computed tomography. J Pediatr Surg. 2001;36(4):565-9.
14. Holmes JF, Brant WE, Bond WF, Sokolove PE, Kuppermann N. Emergency department ultrasonography in the evaluation of hypotensive and normotensive children with blunt abdominal trauma. J Pediatr Surg. 2001;36(7):968-73.
15. Ong AW, McKenney MG, McKenney KA, et al. Predicting the need for laparotomy in pediatric trauma patients on the basis of the ultrasound score. J Trauma Acute Care Surg. 2003;54(3):503-8.
16. Scaife ER, Rollins MD, Barnhart DC, et al. The role of focused abdominal sonography for trauma (FAST) in pediatric trauma evaluation. J Pediatr Surg. 2013;48(6):1377-83.
17. Menaker J, Blumberg S, Wisner DH, et al. Use of the focused assessment with sonography for trauma (FAST) examination and its impact on abdominal computed tomography use in hemodynamically stable children with blunt torso trauma. J Trauma Acute Care Surg. 2014;77(3):427-32.
18. Fenton SJ, Hansen KW, Meyers RL, et al. CT scan and the pediatric trauma patient—are we overdoing it? J Pediatr Surg. 2004;39(12):1877-81.
19. Calder BW, Vogel AM, Zhang J, et al. Focused assessment with sonography for trauma in children after blunt abdominal trauma: a multi-institutional analysis. J Trauma Acute Care Surg. 2017;83(2):218-24.
20. Soudack M, Epelman M, Maor R, et al. Experience with focused abdominal sonography for trauma (FAST) in 313 pediatric patients. J Clin Ultrasound. 2004;32(2):53-61.
21. Richards JR, Knopf NA, Wang L, McGahan JP. Blunt abdominal trauma in children: evaluation with emergency US. Radiology. 2002;222(3):749-54.
22. Benya EC, Lim-Dunham JE, Landrum O, Statter M. Abdominal sonography in examination of children with blunt abdominal trauma. AJR Am J Roentgenol. 2000;174(6):1613-6.
23. Ben-Ishay O, Daoud M, Peled Z, Brauner E, Bahouth H, Kluger Y. Focused abdominal sonography for trauma in the clinical evaluation of children with blunt abdominal trauma. World J Emerg Surg. 2015;10(1):1-6.
24. Fox JC, Boysen M, Gharahbaghian L, et al. Test characteristics of focused assessment of sonography for trauma for clinically significant abdominal free fluid in pediatric blunt abdominal trauma. Acad Emerg Med. 2011;18(5):477-82.
25. Simanovsky N, Hiller N, Lubashevsky N, Rozovsky K. Ultrasonographic evaluation of the free intraperitoneal fluid in asymptomatic children. Pediatr Radiol. 2011;41(6):732-5.
26. Jéquier S, Jéquier J-C, Hanquinet S. Intraperitoneal fluid in children: normal ultrasound findings depend on which scan head you use. Pediatr Radiol. 2003;33(2):86-91.
27. Rathaus V, Grunebaum M, Konen O, et al. Minimal pelvic fluid in asymptomatic children: the value of the sonographic finding. J Ultrasound Med. 2003;22(1):13-7.
28. Sultanoğlu H, Özkan S, Sultanoğlu TE, Kavak N. Comparison of Trauma Scoring Systems in Pediatric Trauma Patients. Eurasian J Emerg Med. 2019;18(1):1-8.
29. Marin JR, Abo AM, Arroyo AC, et al. Pediatric emergency medicine point-of-care ultrasound: summary of the evidence. Crit Ultrasound J. 2016;8(1):1-83.
30. Zeeshan M, Hamidi M, O'Keeffe T, et al. Pediatric liver injury: Physical examination, fast and serum transaminases can serve as a guide. J Surg Res. 2019;242:151-6.
31. Chardouli M, Yasinzadeh M, Meshkini M, et al. A review on using ultrasound for evaluation of pediatric blunt abdominal trauma. Front Emerg Med. 2022;6(1):e8.
2. CE G. Pediatric Trauma. In: Tintinalli JE SJ, Ma OJ, Yealy DM, Meckler GD, Cline DM, editor. Tintinalli's Emergency Medicine: A Comprehensive Study Guide. New York: The Mc Graw Hill Companies; 2016. p. 706-14.
3. Wegner S, Colletti JE, Van Wie D. Pediatric blunt abdominal trauma. Pediatr Clin North Am. 2006;53(2):243-56.
4. Liang T, Roseman E, Gao M, Sinert R. The utility of the focused assessment with sonography in trauma examination in pediatric blunt abdominal trauma: a systematic review and meta-analysis. Pediatr Emerg Care. 2021;37(2):108-18.
5. McGaha Pn, Motghare P, Sarwar Z, et al. Negative Focused Abdominal Sonography for Trauma examination predicts successful nonoperative management in pediatric solid organ injury: A prospective Arizona-Texas-Oklahoma-Memphis-Arkansas+ Consortium study. J Trauma Acute Care Surg. 2019;86(1):86-91.
6. Holmes JF, Lillis K, Monroe D, et al. Identifying children at very low risk of clinically important blunt abdominal injuries. Ann Emerg Med. 2013;62(2):107-16.e2.
7. Retzlaff T, Hirsch W, Till H, Rolle U. Is sonography reliable for the diagnosis of pediatric blunt abdominal trauma? J Pediatr Surg. 2010;45(5):912-5.
8. Kim PK, Zhu X, Houseknecht E, Nickolaus D, Mahboubi S, Nance ML. Effective radiation dose from radiologic studies in pediatric trauma patients. World J Surg. 2005;29(12):1557-62.
9. Tien HC, Tremblay LN, Rizoli SB, et al. Radiation exposure from diagnostic imaging in severely injured trauma patients. J Trauma Acute Care Surg. 2007;62(1):151-6.
10. Rice HE, Frush DP, Farmer D, Waldhausen JH, Committee AE. Review of radiation risks from computed tomography: essentials for the pediatric surgeon. J Pediatr Surg. 2007;42(4):603-7.
11. Holmes JF, Gladman A, Chang CH. Performance of abdominal ultrasonography in pediatric blunt trauma patients: a meta-analysis. J Pediatr Surg. 2007;42(9):1588-94.
12. Coley BD, Mutabagani KH, Martin LC, et al. Focused abdominal sonography for trauma (FAST) in children with blunt abdominal trauma. J Trauma Acute Care Surg. 2000;48(5):902-6.
13. Emery KH, McAneney CM, Racadio JM, Johnson ND, Evora DK, Garcia VF. Absent peritoneal fluid on screening trauma ultrasonography in children: a prospective comparison with computed tomography. J Pediatr Surg. 2001;36(4):565-9.
14. Holmes JF, Brant WE, Bond WF, Sokolove PE, Kuppermann N. Emergency department ultrasonography in the evaluation of hypotensive and normotensive children with blunt abdominal trauma. J Pediatr Surg. 2001;36(7):968-73.
15. Ong AW, McKenney MG, McKenney KA, et al. Predicting the need for laparotomy in pediatric trauma patients on the basis of the ultrasound score. J Trauma Acute Care Surg. 2003;54(3):503-8.
16. Scaife ER, Rollins MD, Barnhart DC, et al. The role of focused abdominal sonography for trauma (FAST) in pediatric trauma evaluation. J Pediatr Surg. 2013;48(6):1377-83.
17. Menaker J, Blumberg S, Wisner DH, et al. Use of the focused assessment with sonography for trauma (FAST) examination and its impact on abdominal computed tomography use in hemodynamically stable children with blunt torso trauma. J Trauma Acute Care Surg. 2014;77(3):427-32.
18. Fenton SJ, Hansen KW, Meyers RL, et al. CT scan and the pediatric trauma patient—are we overdoing it? J Pediatr Surg. 2004;39(12):1877-81.
19. Calder BW, Vogel AM, Zhang J, et al. Focused assessment with sonography for trauma in children after blunt abdominal trauma: a multi-institutional analysis. J Trauma Acute Care Surg. 2017;83(2):218-24.
20. Soudack M, Epelman M, Maor R, et al. Experience with focused abdominal sonography for trauma (FAST) in 313 pediatric patients. J Clin Ultrasound. 2004;32(2):53-61.
21. Richards JR, Knopf NA, Wang L, McGahan JP. Blunt abdominal trauma in children: evaluation with emergency US. Radiology. 2002;222(3):749-54.
22. Benya EC, Lim-Dunham JE, Landrum O, Statter M. Abdominal sonography in examination of children with blunt abdominal trauma. AJR Am J Roentgenol. 2000;174(6):1613-6.
23. Ben-Ishay O, Daoud M, Peled Z, Brauner E, Bahouth H, Kluger Y. Focused abdominal sonography for trauma in the clinical evaluation of children with blunt abdominal trauma. World J Emerg Surg. 2015;10(1):1-6.
24. Fox JC, Boysen M, Gharahbaghian L, et al. Test characteristics of focused assessment of sonography for trauma for clinically significant abdominal free fluid in pediatric blunt abdominal trauma. Acad Emerg Med. 2011;18(5):477-82.
25. Simanovsky N, Hiller N, Lubashevsky N, Rozovsky K. Ultrasonographic evaluation of the free intraperitoneal fluid in asymptomatic children. Pediatr Radiol. 2011;41(6):732-5.
26. Jéquier S, Jéquier J-C, Hanquinet S. Intraperitoneal fluid in children: normal ultrasound findings depend on which scan head you use. Pediatr Radiol. 2003;33(2):86-91.
27. Rathaus V, Grunebaum M, Konen O, et al. Minimal pelvic fluid in asymptomatic children: the value of the sonographic finding. J Ultrasound Med. 2003;22(1):13-7.
28. Sultanoğlu H, Özkan S, Sultanoğlu TE, Kavak N. Comparison of Trauma Scoring Systems in Pediatric Trauma Patients. Eurasian J Emerg Med. 2019;18(1):1-8.
29. Marin JR, Abo AM, Arroyo AC, et al. Pediatric emergency medicine point-of-care ultrasound: summary of the evidence. Crit Ultrasound J. 2016;8(1):1-83.
30. Zeeshan M, Hamidi M, O'Keeffe T, et al. Pediatric liver injury: Physical examination, fast and serum transaminases can serve as a guide. J Surg Res. 2019;242:151-6.
31. Chardouli M, Yasinzadeh M, Meshkini M, et al. A review on using ultrasound for evaluation of pediatric blunt abdominal trauma. Front Emerg Med. 2022;6(1):e8.
| Files | ||
| Issue | Vol 6 No 3 (2022): Summer (July) | |
| Section | Original article | |
| DOI | 10.18502/fem.v6i3.9393 | |
| Keywords | ||
| Abdomen Non-penetrating Wounds Tomography Ultrasonography Wounds and Injuries Pediatrics Child | ||
| Rights and permissions | |
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This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. |
How to Cite
1.
Sultanoglu H, Basaran A, Hekimoglu A, Arslan ED, Ozkan S. Ultrasound versus computed tomography scan findings in pediatric blunt abdominal traumas. Front Emerg Med. 2022;6(3):e31.
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