Clinical scenario

A 6 year old boy presents to the emergency department after falling out of a fast moving car. He is extremely distressed and appears to have sustained multiple injuries including a large laceration to his head, bruising and deformity to both forearms and his left lower leg. After initial assessment and stabilisation you decide to paralyse, intubate, and vetilate him before performing a head CT. However you are also concerned about the possibility of an intra-abdominal injury. You wonder whether an ultrasound or CT would be better at identifying this.

Three part question

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

Search strategy

Medline 1966–07/02 using the OVID interface. [exp abdominal injuries OR “abdominal injur$”.mp OR “abdominal trauma$”.mp] AND [exp tomography, x-ray computed OR “computed tomograph$”.mp OR “computerised tomograph$”.mp OR CT.mp] AND [exp ultrasonography OR ultrasonography.mp OR exp ultrasonics OR ultrasonics.mp Or ultrasound.mp] AND [exp adolescence OR exp child OR exp child of impaired parents OR exp child, abandoned OR exp child, exceptional OR exp child, hospitalised OR exp child, institutionalised OR exp child, preschool OR exp child, unwanted OR exp disabled children OR exp homeless youth/ OR exp infant OR exp only child OR child$.mp OR exp Pediatrics OR pediatric$.mp OR paediatric$.mp] LIMIT to human AND English.

Search outcome

Altogether 123 papers were found, of which 117 were irrelevant or of insufficient quality. The remaining six papers are shown in table 6.

Comment(s)

The studies do seem to indicate that CT is better than ultrasound at identifying intra-abdominal injury in children. However, as it is impossible to confirm most of the injuries identified on imaging, it is also difficult to compare the two imaging techniques with a definite gold standard.

This also needs to be considered in the light of the clinical scenarios encountered by emergency physicians. Because of the need for transport and the time it takes to perform CT, children with blunt abdominal trauma need to be stable and have no other injuries requiring urgent treatment. Most will also require sedation. Ultrasound can be performed in the resuscitation room, is much quicker, and is much less distressing to a terrified child.

▸ CLINICAL BOTTOM LINE

CT is better than ultrasound at identifying intra-abdominal injury in children.