[Usefulness of ultrasonography in the initial assessment of blunt abdominal trauma in children].
Abdominal injuries are frequent in children, and the early assessment is the best guaranty for an accurate management. Although computed tomography (TAC) has been considered the diagnostic modality of choice for children with blunt abdominal trauma, is a costly radiological test that requires the patients be stable and sedated. The aim of this study is to evaluate the usefulness of abdominal ultrasonography, a quick, non-invasive technique, of low cost, and repeatable, during the initial assessment of these patients, arguing about the possibility of replace TAC in the detection of intra-abdominal posttraumatic injury. A retrospective case note review was carried out on the 22 children of less than 8 year-old admitted with blunt abdominal trauma to the Pediatric Surgery Section of our institution between 1991 and 1999. The most common mechanism of injury has been the motor vehicle accident (63.63%). All were initially evaluated with ultrasonography and those with any abnormal ultrasonographic findings (free intraperitoneal fluid, intra-abdominal organ injury) were further evaluated with computed tomography and/or repeated sonographies. Sensitivity, specificity, positive predictive value, negative predictive value, and accuracy o the diagnostic methods, have been evaluated. This investigation found abnormalities in 17 patients, 70.59% of whom have been managed conservatively. The accuracy of the abdominal ultrasound in the diagnosis of intra-abdominal injury was 77.27%, with a 82.35% sensitivity, 60% especificity, 87.5% positive predictive value, and 50% negative predictive value. The accuracy of the TAC in the diagnosis was 93.75%. The sensitivity, specificity, positive predictive value, and negative predictive value of the TAC were 92.85%, 100%, 100%, and 66% respectively. We conclude that TAC is the imaging modality of choice in children with severe abdominal trauma but ultrasonography is a reasonable technique to arouse diagnostic suspicion, that can avoid additional tomographic studies. Abdominal computed tomography must be reserved for the hemodynamically stable children with anormal ultrasonographic findings or with suspected injuries by a clinical evolution that gone unnoticed in the previous study.
Fernández Córdoba
M S
MS
Sección de Cirugía Pediátrica, Complejo Hospitalario de Albacete, Albacete.
Gonzálvez Piñera
J
J
Puertas Hernández
F
F
Marco Macián
A
A
D000007:Abdominal Injuries / Q000000981:diagnostic imaging*; D000465:Algorithms; D002675:Child, Preschool; D005260:Female; D006801:Humans; D008297:Male; D015203:Reproducibility of Results; D012189:Retrospective Studies; D014463:Ultrasonography; D014949:Wounds, Nonpenetrating / Q000000981:diagnostic imaging*