Selection and Nonoperative Management of Pediatric Blunt Trauma Patients: The Role of Quantitative Crystalloid Resuscitation and Abdominal Ultrasonography

Dj, Hoelzer; Mb, Brian; Vj, Balsara; Wd, Varner; Tc, Flynn; Me, Miner

doi:10.1097/00005373-198601000-00011

Cited by 33 publications

(6 citation statements)

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“…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).…”

Section: Introductionmentioning

confidence: 99%

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

Zamani

Heydari

Esmailian

2018

J Emerg Pract Trauma

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Objective: The present study examines the diagnostic accuracy of abdominal ultrasonography and urinalysis test in children with blunt abdominal trauma, compared with CT scan. The aim of this study was to compare the diagnostic value of ultrasound and urinalysis test with CT scan as a golden standard diagnostic method in predicting abdominal peritoneal injury in these patients. Methods: This prospective study, based on diagnostic accuracy evaluation, was performed on children with blunt abdominal traumas less than 12 years of age who were referred to the emergency department from 2017-2018 and for whom abdominal ultrasonography, urinalysis and abdominal CT scans were requested. Demographic data, mechanism of trauma, the results of urine tests, ultrasound and CT scan of the abdomen were recorded. Sensitivity, specificity, positive and negative predictive values were used to measure the diagnostic power of the tests. Results: In this study, 100 children with multiple traumas were included. The mean age of these patients was 5.75 ± 3 years with a range of 1-12 years. In terms of sexual distribution, 69 (69%) were boys and 31 (31%) were girls. According to the results, ultrasound with an abnormal urinalysis test had sensitivity of 85.7%, specificity of 91.9%, positive predictive value of 63.2% and negative predictive value of 97.5%. The accuracy was 91%. Conclusion: According to the results of this study, the combination of ultrasonography and urinalysis resulted in a significant increase in diagnostic value (P <0.001). Pediatric patients with a negative ultrasonography and urinalysis test should be observed rather than subjected to the radiation risk of CT

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Section: Introductionmentioning

confidence: 99%

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

Zamani

Heydari

Esmailian

2018

J Emerg Pract Trauma

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“…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.…”

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confidence: 99%

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

Fox

Boysen

Gharahbaghian

et al. 2011

Academic Emergency Medicine

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Objectives: Focused assessment of sonography in trauma (FAST) has been shown useful to detect clinically significant hemoperitoneum in adults, but not in children. The objectives were to determine test characteristics for clinically important intraperitoneal free fluid (FF) in pediatric blunt abdominal trauma (BAT) using computed tomography (CT) or surgery as criterion reference and, second, to determine the test characteristics of FAST to detect any amount of intraperitoneal FF as detected by CT. Results: The study enrolled 431 patients, excluded 74, and analyzed data on 357. For the first objective, 23 patients had significant hemoperitoneum (22 on CT and one at surgery). Twelve of the 23 had true-positive FAST (sensitivity = 52%; 95% confidence interval [CI] = 31% to 73%). FAST was true negative in 321 of 334 (specificity = 96%; 95% CI = 93% to 98%). Twelve of 25 patients with positive FAST had significant FF on CT (positive predictive value [PPV] = 48%; 95% CI = 28% to 69%). Of 332 patients with negative FAST, 321 had no significant fluid on CT (negative predictive value [NPV] = 97%; 95% CI = 94% to 98%). Positive likelihood ratio (LR) for FF was 13.4 (95% CI = 6.9 to 26.0) while the negative LR was 0.50 (95% CI = 0.32 to 0.76). Accuracy was 93% (333 of 357, 95% CI = 90% to 96%). For the second objective, test characteristics were as follows: sensitivity = 20% (95% CI = 13% to 30%), specificity = 98% (95% CI = 95% to 99%), PPV = 76% (95% CI = 54% to 90%), NPV = 78% (95% CI = 73% to 82%), positive LR = 9.0 (95% CI = 3.7 to 21.8), negative LR = 0.81 (95% CI = 0.7 to 0.9), and accuracy = 78% (277 of 357, 95% CI = 73% to 82%). Conclusion:In this population of children with BAT, FAST has a low sensitivity for clinically important FF but has high specificity. A positive FAST suggests hemoperitoneum and abdominal injury, while a negative FAST aids little in decision-making.

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“…34 Ultrasound has the potential to fundamentally change how we teach and practice medicine to the benefit of learners and patients across the globe. 15 Ultrasound waves are used in sonology to depict body structures, while radiology is an electromagnetic radiation-based modality. 16 There is a great deal of difference between the ultrasound image and the image generated by radiation.…”

Section: Discussionmentioning

confidence: 99%

Reliability of Focused Assessment With Sonography for Trauma in the Diagnosis of Blunt Torso Trauma

Ullah

Bacha

Manzoor

et al. 2021

Journal of Diagnostic Medical Sonography

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Objective: Focused assessment with sonography for trauma (FAST) is a widely used imaging technique for the diagnosis of blunt abdominal trauma and has its limitations and advantages. A meta-analysis was completed to evaluate the reliability of FAST, in the diagnosis of blunt torso trauma. Materials and Methods: A search was completed with Google Scholar, PubMed, National Center for Biotechnology Information (NCBI), MEDLINE, and Medscape databases, from 1993 up to 2020. Eligible studies were included for information about FAST examination of abdominal trauma. The animal research was excluded from this review process. The eligible studies were first categorized and then data analysis was performed, according to specific pathologic conditions. This literature review retrieved studies’ sample size, application, sensitivity, and a specificity of diagnosis using FAST for abdominal trauma. Results: In total, 100 articles were identified through the database search. Besides, five articles were identified through other sources. Then, screening was performed, and as such, 46 published studies were included that had a qualitative synthesis. Conclusion: FAST has a high sensitivity and specificity in the diagnosis of blunt abdominal trauma. However, a large range of sensitivity and specificity of FAST in the evaluation of torso trauma reveal that sonography is operator, technique, and equipment dependent.

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Selection and Nonoperative Management of Pediatric Blunt Trauma Patients: The Role of Quantitative Crystalloid Resuscitation and Abdominal Ultrasonography

Cited by 33 publications

References 0 publications

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

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

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

Reliability of Focused Assessment With Sonography for Trauma in the Diagnosis of Blunt Torso Trauma

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