Initial Evaluation of Children Sustaining Blunt Abdominal Trauma: Ultrasonography vs. Diagnostic Peritoneal Lavage

Abstract

A prospective clinical study was performed to compare ultrasonography (US) with a modality having 96-99% accuracy like diagnostic peritoneal lavage (DPL) to find the accuracy of US in the initial evaluation of children sustaining blunt abdominal trauma (BAT). Sixty-eight children with BAT were initially evaluated by US, then DPL. All patients with pathologic US findings underwent computerized tomographic examination before DPL to confirm the pathologies. Through US examination free intraperitoneal fluid (FIF) was present in eleven, absent in 57 patients. DPL was positive in ten, negative in 58 patients. Sensitivity, specificity, negative predictive value, positive predictive value and efficiency of US were 100, 98.3, 100, 91 and 98.5 respectively. US detected intraperitoneal solid organ injuries in eleven patients, but DPL was positive in only ten of these patients. While US detected renal injuries in six patients and intrapleural fluid in two patients, DPL was positive in only two of these patients as a result of concomitant intraperitoneal solid organ injuries with FIF. The present study has shown that US can detect FIF with a high rate of accuracy comparable to DPL in children. In addition, US has advantages over DPL in the detection of intraperitoneal organ injuries with or without concomitant FIF, retroperitoneal injuries and intrathoracic injuries. Thus US is thought to be superior to DPL and recommended as a routine first choice screening tool in the initial evaluation of children sustaining BAT.

Diagnostic accuracy of eFAST in the trauma patient: a systematic review and meta-analysis

“…Six studies included only pediatric patients. [22][23][24][25][26][27] Eight additional studies included patients of all ages (pediatric and adult) but did not stratify patients based on age. [28][29][30][31][32][33][34][35] Five papers included only hypotensive patients (systolic blood pressure [sBP] of <90 mm Hg).…”

FAST and abnormal urinalysis: the effective screening tools in pediatric abdominal trauma

“…Computed tomography scans have been identified as standard diagnostic tools, but CT-scan is not available in all areas and treatment centers and therefore efforts are needed to achieve a tool that can accurately determine the patient's condition. In this regard, some studies have shown the role of ultrasound in detecting such injuries (8)(9)(10)(11)(12)(13)(14). On the other hand, the presence of blood or blood elements in the urine from the past has been recognized as a predictive criterion for urinary tract damage, as well as severity of injury to other organs, and urinalysis is one of the most common evaluations in these patients, and according to these measures the next diagnosis is done (15).…”

Test Characteristics of Focused Assessment of Sonography for Trauma for Clinically Significant Abdominal Free Fluid in Pediatric Blunt Abdominal Trauma

“…Previous studies had few patients, 9,10 were retrospective, 11,12 used unrealistic definitions of FF, or had overly stringent criterion references (need for operation) 13–15 . Consequently, reports of test characteristics vary widely 9–11,13–17 . Pediatric trauma management rarely involves surgery, but important decisions may depend on FAST, such as the need for intensive care, transfer to higher level care, prioritization of multiple victims, and type and volume of resuscitation.…”