Blunt abdominal trauma in children: evaluation with emergency US.
OBJECTIVE
To assess the accuracy of emergency abdominal ultrasonography (US) in the detection of both hemoperitoneum and parenchymal organ injury in children.


METHODS
Imaging findings were recorded prospectively in 744 consecutive children who underwent emergency US from January 1995 to October 1998; free fluid and parenchymal abnormalities of specific organs were also noted. Patients with intraabdominal injuries were identified retrospectively. Computed tomographic (CT) findings, intraoperative findings, and clinical outcome were compared with the initial US findings. Sensitivity, specificity, and positive and negative predictive values were calculated for patients who underwent CT, laparotomy, or both after US.


RESULTS
Seventy-five (10%) of 744 patients had intraabdominal injuries, and US depicted free fluid in 42 of them. US had 56% sensitivity, 97% specificity, 82% positive predictive value, and 91% negative predictive value for detection of hemoperitoneum alone. US helped identify parenchymal abnormalities that corresponded to actual organ injury without accompanying free fluid in nine patients (12%). Inclusion of identification of parenchymal organ injury at US increased the sensitivity of US to 68%, with an accuracy of 92%.


CONCLUSIONS
US for blunt abdominal trauma in children is highly accurate and specific, but moderately sensitive, for detection of intraabdominal injury.
Richards
John R
JR
Division of Emergency Medicine, University of California, Davis Medical Center, PSSB 2100, 2315 Stockton Blvd, Sacramento, CA 95817, USA. jrrichards@ucdavis.ca
Knopf
Nicolette A
NA
Wang
Lianyi
L
McGahan
John P
JP
D000005:Abdomen / Q000000981:diagnostic imaging*; D000007:Abdominal Injuries / Q000000981:diagnostic imaging*; D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D004630:Emergencies; D005260:Female; D006465:Hemoperitoneum / Q000000981:diagnostic imaging; D006801:Humans; D008297:Male; D011237:Predictive Value of Tests; D011446:Prospective Studies; D011860:Radiography, Abdominal; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed; D014463:Ultrasonography; D014949:Wounds, Nonpenetrating / Q000000981:diagnostic imaging*