Predicting the need for laparotomy in pediatric trauma patients on the basis of the ultrasound score.
BACKGROUND
It is possible to quantify the amount of hemoperitoneum seen on focused assessment with sonography for trauma (FAST) using a simple scoring system that had previously been shown to correlate with the need for subsequent laparotomy in adults. A score of 3 or greater was shown to be highly accurate in predicting the need for laparotomy. We hypothesized that this scoring system might also predict the need for laparotomy in pediatric trauma patients.


METHODS
We retrospectively reviewed all records for patients 15 years and younger who underwent FAST after blunt trauma. A "positive" ultrasound examination was defined as one containing free intraperitoneal fluid with or without solid organ injury. The ultrasound score (USS) was defined as the depth of the deepest pocket of fluid collection measured in centimeters plus the number of additional spaces where fluid was seen.


RESULTS
Thirty-eight (19.6%) of 193 patients who had FAST performed had positive ultrasound examinations. Thirty-seven patients with complete records were analyzed. There were no differences between patients with a USS < or = 3.0 and those with a USS > 3.0 in terms of admission pulse, Glasgow Coma Scale score, Injury Severity Score, or the proportion of patients who were initially hypotensive. One of 22 patients with a USS < or = 3.0 required therapeutic laparotomy versus 8 of 15 patients with a USS > 3.0 ( = 0.002). For a USS > 3.0, sensitivity, specificity, and accuracy in predicting therapeutic laparotomy were 89%, 75%, and 78%, respectively.


CONCLUSIONS
Ultrasound quantification of hemoperitoneum by a simple scoring system may serve as a useful adjunct to traditional clinical parameters in predicting the need for subsequent laparotomy in pediatric patients. Prospective validation with a larger study is required.
Ong
Adrian W
AW
Department of Surgery, University of Miami Medical School, FL, USA. aong@wpahs.org
McKenney
Mark G
MG
McKenney
Kimberley A
KA
Brown
Margaret
M
Namias
Nicholas
N
MaCloud
Jana
J
Cohn
Stephen M
SM
D000293:Adolescent; D002648:Child; D015600:Glasgow Coma Scale; D006465:Hemoperitoneum / Q000145:classification / Q000000981:diagnostic imaging* / Q000601:surgery; D006801:Humans; D015601:Injury Severity Score; D007813:Laparotomy; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D014193:Trauma Centers / Q000706:statistics & numerical data; D014463:Ultrasonography; D014949:Wounds, Nonpenetrating / Q000145:classification / Q000000981:diagnostic imaging* / Q000601:surgery