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Management of Pediatric Blunt Abdominal Trauma at a Major Trauma Centre: Is Ultrasound a Reliable Indicator of Injury? - Abstract

Muhammad Riyad Peeraully, Paul Berkeley Jackson, Ramnik Patel, Shailinder Jit Singh


ABSTRACT

Introduction: Abdominal computed tomography (CT) is the gold standard for investigation of blunt abdominal trauma but involves significant radiation exposure which is of especial concern in the pediatric population. Conservative management of stable solid viscus injuries (SVI) in children is successful but risks delayed management of associated hollow viscus injuries (HVI). This retrospective cohort study analyses the management of paediatric blunt abdominal trauma at a major trauma centre.

Methods: For the period 2007-2012, we identified patients less than 16 years admitted to our hospital with blunt abdominal trauma that underwent emergency abdominal imaging. Demographic and clinical data were obtained from contemporaneous records.

Results: Forty-four children were identified for inclusion. Thirteen (30%) underwent formal abdominal ultrasound (US) prior to CT. There were no false negatives (sensitivity 100%) or false positives (specificity 100%) on US in comparison to CT. Nine (20%) were investigated with US alone and managed non-operatively. There was normal imaging in 19 (43%), SVI in 20 (45%) and free intraperitoneal fluid (FIPF) without SVI in 5 (11%). Management was conservative in 40 (91%), including 2 (5%) who had FIPF without SVI. Four (9%) underwent laparotomy, two having free intraperitoneal air and two having FIPF without SVI.

Conclusion: This study identified no difference in sensitivity or specificity between US (performed by a paediatric radiologist) and CT in detecting intra-abdominal injury. In stable children with evidence of FIPF but no definite SVI or HVI, a conservative approach may be appropriate with consideration for serial imaging and a low threshold for surgical intervention.

Keywords: child, abdominal injuries, laparotomy, ultrasonography, tomography, radiograph, computed axial tomogram (CAT)

 

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