Focused abdominal sonography for trauma in the clinical evaluation of children with blunt abdominal trauma

Ben-Ishay, Offir; Daoud, Mai; Peled, Zvi; Brauner, Eran; Bahouth, Hany; Kluger, Yoram

doi:10.1186/s13017-015-0021-x

Cited by 6 publications

(5 citation statements)

References 19 publications

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“…Our patient presented tachycardia, low blood pressure and altered mental status. Although inclusion of FAST exams in routine trauma care may or may not have benefit for stable patients, it remains to be essential in the evaluation of unstable children 11…”

Section: Discussionmentioning

confidence: 99%

Successful management of life-threatening cardiac tamponade by pericardial aspiration in a boy following blunt trauma to the chest

2022

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A 7-year-old boy was presented with significant chest pain, reduced consciousness with haemodynamic instability following a minor blunt trauma to the chest. He was diagnosed to have a life-threatening pericardial effusion in FAST (Focused Assessment with Sonography for Trauma scan) ultrasound examination which was confirmed as haemopericardium causing cardiac tamponade in 2D echocardiogram. Emergency cardiac catheterisation ruled out active bleeding and prompt pericardiocentesis under fluoroscopy guidance rapidly restored patients’ haemodynamic parameters. He was successfully discharged without complications after a few days. This case report highlights uncommon presentation of cardiac tamponade without major cardiac injury after a minor blunt trauma in a paediatric patient which was detected early and successfully managed without complications.

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Section: Discussionmentioning

confidence: 99%

Successful management of life-threatening cardiac tamponade by pericardial aspiration in a boy following blunt trauma to the chest

2022

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“…Regarding what was mentioned above, we have tried to create diagnostic algorithms involving the FAST echo (Focused Abdominal Sonography for Trauma) which, when having a negative result, strongly suggests the absence of major intra-abdominal trauma with a high negative predictive value, defining the patient group who would benefit from a larger study, such as CAT 33,34 . Conventional ultrasound has been used, together with the clinical parameters described above and serial clinical evaluation, as a safe method of diagnosis that allows surgical decision making and to select those patients who really need to be taken to tomographic studies.…”

Section: Discussionmentioning

confidence: 99%

Factores asociados a falla en el manejo no operatorio de lesiones hepáticas o esplénicas secundarias a trauma abdominal cerrado en niños

Medina

Uribe

et al. 2017

Rev. chil. pediatr.

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Results: 70 patients were admitted with blunt abdominal trauma, 3 were excluded for immediate surgery (2 hemodynamic instability, 1 peritoneal irritation). Of 67 patients who received NOM, 58 were successful and 9 showed failure (8 hemodynamic instability, 1 hollow viscera injury). We found 3 factors associated with failure NOM: blood pressure (BP) < 90 mmHg at admission (p = 0.0126; RR = 5.19), drop in hemoglobin (Hb) > 2 g/ dl in the first 24 hours (p = 0.0009; RR = 15.3), and transfusion of 3 or more units of red blood cells (RBC) (0.00001; RR = 17.1). Mechanism and severity of trauma and Pediatric Trauma Index were not associated with failure NOM. Conclusions: Children with blunted hepatic or splenic trauma respond to NOM. Factors such as BP < 90 mmHg at admission, an Hb fall > 2 g/dl in the first 24 hours and transfusion of 3 or more units of RBC were associated with the failure in NOM.

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“…CEUS exam has to be performed after baseline US of the abdomen and pelvis [6,12]. CEUS uses second-generation contrast agents (USCAs) and dedicated software operating at low mechanical index, which is able to recognize the resonance signals produced by the USCAs.…”

Section: Ceus Techniquementioning

confidence: 99%

“…The first imaging technique performed on a child who has sustained a low-energy trauma is ultrasound (US). Despite its own limitations, such as being strongly operator dependent and body-type dependent, it has several positive features, including its high availability, the lack of radio-exposure, and its high sensitivity for very small amounts of hemoperitoneum [6][7][8][9][10][11][12][13].…”

Section: Introductionmentioning

confidence: 99%

“…In case of a hemodynamically unstable patient, "Focused Abdominal Sonography in Trauma" (FAST) or the Extended-to-thorax FAST (E-FAST) [15] should be performed during resuscitation maneuvers in the emergency room, to recognize the potential causes of "preventable" death in a very short time, such as pneumothorax (PNX), hemothorax, hemopericardium, or hemoperitoneum, as well as to evaluate the caval filling. Some studies, while supporting the usefulness of FAST, have emphasized its low sensitivity and specificity in depicting hemoperitoneum in patients aged 2 years [6,12]. Only after the patient's hemodynamic stability is achieved can total body contrast-enhanced CT be performed to correctly stage the disease.…”

Section: Introductionmentioning

confidence: 99%

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Contrast-enhanced ultrasound (CEUS) in pediatric blunt abdominal trauma

Trinci

Piccolo²,

Ferrari

et al. 2018

J Ultrasound

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Baseline ultrasound is the first-choice technique in traumatic hemodynamically stable children, and is essential in the early assessment of unstable patients to detect hemoperitoneum or other potentially fatal conditions. Despite the technological advancements in new ultrasound equipment and the experience of the operators, it is not always possible to rule out the presence of parenchymal traumatic lesions by means of baseline ultrasound nor to suspect them, especially in the absence of hemoperitoneum. For this reason, in the last decades, basic ultrasound has been associated with contrast-enhanced ultrasound (CEUS) to evaluate the stable little patient in cases such as low-energy blunt abdominal trauma. Because it relies on second-generation contrast agents, the CEUS technique allows for better detection of parenchymal injuries. CEUS has been demonstrated to be almost as sensitive as contrast-enhanced CT in the detection of traumatic injuries in patients affected by low-energy isolated abdominal trauma, with levels of sensitivity and specificity up to 95%. A very important point in favor of CEUS is its capacity to help distinguish the healthy patient, who can be discharged, from the one needing prolonged monitoring, operative management or hospitalization. Finally, we also have the ability to follow-up on low-grade traumatic lesions using CEUS, always keeping in mind patients' clinical conditions and their hemodynamics. Keywords Pediatric blunt abdominal trauma • Contrast-enhanced ultrasound • CEUS • Follow-up • Emergency radiology • Trauma imaging SommarioIl trauma rappresenta una importante causa di morbidità e mortalità infantile ed il trauma chiuso dell'addome è responsabile di circa l' 80-90% delle lesioni addominali. Il meccanismo traumatico è abbastanza simile a quello che si verifica nell'adulto, con significative differenze fisiologiche tra le due classi di età responsabili di un sempre maggior utilizzo del management non operativo in età infantile. In caso di trauma a bassa energia l'imaging può essere effettuato con la CEUS, una tecnica diagnostica in grado di evidenziare le lesioni traumatiche addominali con un' accuratezza diagnostica molto vicina a quella della TC con mdc. Tuttavia, per alcune lesioni traumatiche, come quelle che interessano le vie urinarie, la TC con mdc resta la metodica di scelta, in ragione della sua elevata sensibilità ed accuratezza, in grado di distinguere tra un leakage retroperitoneale o intraperitoneale, guidando quindi anche il management terapeutico. Il fegato è l'organo più comunemente interessato dalle lesioni traumatiche addominali, seguito dalla milza. Le lesioni renali e pancreatiche sono piuttosto rare. In questa review gli autori si propongono di presentare i reperti di imaging più comuni in corso di trauma chiuso dell'addome infantile con CEUS e relativo confronto con la TC.

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Focused abdominal sonography for trauma in the clinical evaluation of children with blunt abdominal trauma

Cited by 6 publications

References 19 publications

Successful management of life-threatening cardiac tamponade by pericardial aspiration in a boy following blunt trauma to the chest

Successful management of life-threatening cardiac tamponade by pericardial aspiration in a boy following blunt trauma to the chest

Factores asociados a falla en el manejo no operatorio de lesiones hepáticas o esplénicas secundarias a trauma abdominal cerrado en niños

Contrast-enhanced ultrasound (CEUS) in pediatric blunt abdominal trauma

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