Blunt abdominal trauma in children: a score to predict the absence of organ injury

Is sonography reliable for the diagnosis of pediatric blunt abdominal trauma?

“…However, complete sonographic assessment of the affected children requires initial FAST investigation combined with follow-up investigations [26][27][28].…”

Blunt abdominal trauma in children

“…The Blunt Abdominal Trauma in Children (BATiC) score combined the results of abdominal Doppler ultrasound with three physical exam findings and six laboratory values to identify children with IAI without CT imaging. Each element in the score was assigned a value, and a score of 7 or less had a sensitivity of 91%, specificity 84%, PPV 64%, and NPV 97% for the detection of intra-abdominal organ injury [19]. To improve the ability of ultrasound to identify solid organ injuries in children, contrast enhanced ultrasound (CEUS), which uses intravenous contrast, has been shown to accurately visualize intra-abdominal parenchymal injury [20].…”

“…Unfortunately, children who are initially evaluated with abdominal CTs at community hospitals frequently undergo repeat CT scans after transfer to pediatric trauma centers, further increasing their exposure to ionizing radiation [27 & ,28]. Given these radiation risks, there are ongoing attempts to help clinicians risk stratify patients for IAI with clinical prediction rules [19,29]. In 2009 Holmes et al [29] prospectively validated their previously derived clinical prediction rule for the identification of children at very low risk for IAI after blunt torso trauma.…”

Blunt Spleen and Liver Trauma

“…3 Another series of 99 patients incorporated abdominal ultrasound along with examination, vitals and laboratory values and arrived at an NPV of 97% and a specificity of 84%. 7 This protocol was further validated in a subsequent study. 8 A large prospective trial that used only history and physical examination findings identified patients at very low risk for intraabdominal injury, and therefore would not need an abdominal CT. 9 While ultrasound and clinical examination are not quite as sensitive as CT using these algorithms, or other similar protocols, may help guide selective and efficient use of CT in suspected abdominal trauma.…”