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Best evidence topic report
The accuracy of abdominal ultrasound in paediatric trauma
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  1. Ross Murphy,
  2. Angaj Ghosh
  1. Department of Emergency Medicine, Manchester Royal Infirmary, Oxford Road, Manchester M13 9WL, UK
  1. Correspondence to: Kevin Mackway-Jones, Consultant (kevin.mackway-jones{at}man.ac.uk)

http://dx.doi.org/10.1136/emj.18.3.208-a

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    Report by Ross Murphy, Senior Clinical Fellow Search checked by Angaj Ghosh, Senior Clinical Fellow

    Clinical scenario

    An 8 year old boy is taken to the emergency department after falling out of a tree. He has no signs of injury apart from abrasions and tenderness across his upper abdomen; he is haemodynamically stable. He undergoes an abdominal ultrasound that is normal but you wonder how accurate this is at identifying intra-abdominal injury compared with the current gold standard, abdominal computed tomography.

    Three part question

    In [a paediatric patient with blunt abdominal trauma] how [accurate is an ultrasound scan] at [identifying intra-abdominal injury]?

    Search strategy

    Medline 1966–12/00 using the OVID interface. {[(exp child OR children.mp OR exp pediatrics OR pediatric.mp OR paediatric.mp) AND (exp abdominal injuries OR abdominal trauma.mp)] AND (exp tomography, x-ray computed OR CT.mp OR computerised tomography.mp OR exp ultrasonography OR ultrasonography.mp OR exp ultrasonics OR ultrasonics.mp OR ultrasound.mp)} LIMIT to human AND english.

    Search outcome

    Altogether 511 papers found of which 505 were irrelevant or of insufficient quality. The remaining six papers are shown in table 1.

    View this table:
    Table 1

    Comments

    The evidence indicates a variability in the accuracy of ultrasound at identifying intra-abdominal injury in children. This is probably related to the skill of the ultrasonographer. Ultrasound can have a high diagnostic specificity and it may be useful as part of a rule in strategy in these situations. Focused abdominal sonography for trauma (FAST) seems to be neither sensitive nor specific enough.

    Clinical bottom line

    Abdominal ultrasound can be used to rule in intra-abdominal fluid or organ damage in children. Negative ultrasound does not rule out intra-abdominal injury and, if clinical suspicion persists, abdominal compted tomography with contrast should be performed.

    Report by Ross Murphy, Senior Clinical Fellow Search checked by Angaj Ghosh, Senior Clinical Fellow

    References

    1. Krupnick AS, Teitelbaum DH, Geiger JD, et al. Use of abdominal ultrasonography to assess paediatric splenic trauma. Potential pitfalls in the diagnosis. Ann Surg1997;225:408–14.
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    2. Richardson MC, Hollman AS, Davis CF. Comparison of computed tomography and ultrasonographic imaging in the assessment of blunt abdominal trauma in children. Br J Surg1997;84:1144–6.
      OpenUrlCrossRefPubMedWeb of Science
    3. Partrick DA, Bensard DD, Moore EE, et al. Ultrasound is an effective triage tool to evaluate blunt abdominal trauma in the pediatric population. J Trauma1998;45:57–63.
      OpenUrlPubMedWeb of Science
    4. Mutabagani KH, Coley BD, Zumberge N, et al. Preliminary experience with focussed abdominal sonography for trauma (FAST) in children: Is it useful? J Paediatr Surg1999;34:48–52.
      OpenUrlCrossRefPubMedWeb of Science
    5. Benya EC, Lim-Dunham JE, Landrum O, et al. Abdominal sonography in examination of children with blunt abdominal trauma. Am J Roenterol2000;174:1613–6.
      OpenUrlPubMedWeb of Science
    6. Coley BD, Mutabagani KH, Martin LC, et al. Focused abdominal sonography for trauma (FAST) in children with blunt abdominal trauma. J Trauma2000;48:902–6.
      OpenUrlPubMedWeb of Science