Evaluation for intra-abdominal injury in children after blunt torso trauma

Streck, Christian J.; Jewett, Brent; Wahlquist, Amy H.; Gutierrez, Peter S.; Russell, W. Scott

doi:10.1097/ta.0b013e31825840ab

Cited by 82 publications

(31 citation statements)

References 23 publications

(28 reference statements)

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“…Although CT scans are considered the primary diagnostic modality for the evaluation of haemodynamically stable children with torso trauma, there are concerns of cost and the potential for radiation-associated malignancies. 9 Recently, a clinical decision rule (CDR) has been suggested to identify children who are at very low risk of intra-abdominal injuries and hence would not require abdominal CTs; however, although costeffective, the validity of this CDR still requires further research. 9,10 In the current study, the CT scan rate appears high; however, this may be because all children with torso trauma detected on CT scans were included in the study cohort.…”

Section: Discussionmentioning

confidence: 99%

“…9 Recently, a clinical decision rule (CDR) has been suggested to identify children who are at very low risk of intra-abdominal injuries and hence would not require abdominal CTs; however, although costeffective, the validity of this CDR still requires further research. 9,10 In the current study, the CT scan rate appears high; however, this may be because all children with torso trauma detected on CT scans were included in the study cohort. Hence, the exact CT scan rate for children presenting with torso trauma at SQUH is unknown.…”

Section: Discussionmentioning

confidence: 99%

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Paediatric Blunt Torso Trauma: Injury mechanisms, patterns and outcomes among children requiring hospitalisation at the Sultan Qaboos University Hospital, Oman

Bhatti

Taqi

Al-Harthy

et al. 2016

SQUMJ

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abstract:Objectives: Trauma is the greatest cause of morbidity and mortality in paediatric/adolescent populations worldwide. This study aimed to describe trauma mechanisms, patterns and outcomes among children with blunt torso trauma admitted to the Sultan Qaboos University Hospital (SQUH) in Muscat, Oman. Methods: This retrospective single-centre study involved all children ≤12 years old with blunt torso trauma admitted for paediatric surgical care at SQUH between January 2009 and December 2013. Medical records were analysed to collect demographic and clinical data. Results: A total of 70 children were admitted with blunt torso trauma during the study period, including 39 (55.7%) male patients. The mean age was 5.19 ± 2.66 years. Of the cohort, 35 children (50.0%) received their injuries after having been hit by cars as pedestrians, while 19 (27.1%) were injured by falls, 12 (17.1%) during car accidents as passengers and four (5.7%) by falling heavy objects. According to computed tomography scans, thoracic injuries were most common (65.7%), followed by abdominal injuries (42.9%). The most commonly involved solid organs were the liver (15.7%) and spleen (11.4%). The majority of the patients were managed conservatively (92.9%) with a good outcome (74.3%). The mortality rate was 7.1%. Most deaths were due to multisystem involvement. Conclusion: Among children with blunt torso trauma admitted to SQUH, the main mechanism of injury was motor vehicle accidents. As a result, parental education and enforcement of infant car seat/child seat belt laws are recommended. Conservative management was the most successful approach. Keywords

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Paediatric Blunt Torso Trauma: Injury mechanisms, patterns and outcomes among children requiring hospitalisation at the Sultan Qaboos University Hospital, Oman

Bhatti

Taqi

Al-Harthy

et al. 2016

SQUMJ

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“…Additionally, the AST and ALT concentrations are reportedly sensitive diagnostic markers with which to evaluate the degree of trauma caused by blunt hepatic injuries. 20 , 21 …”

Section: Discussionmentioning

confidence: 99%

Effectiveness of contrast-enhanced ultrasound and serum liver enzyme measurement in detection and classification of blunt liver trauma

et al. 2017

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ObjectiveThis study was performed to identify the correlation between contrast-enhanced ultrasound (CEUS) and contrast-enhanced multidetector computed tomography (CE-MDCT) as well as the correlation between serum liver enzyme concentrations and CE-MDCT in classification of the severity of blunt hepatic trauma using CE-MDCT as a reference standard.Materials and methodsA blunt liver trauma model was created using 20 rabbits, and CE-MDCT, CEUS, and serum liver enzyme assays were performed. A radiologist and an ultrasound physician independently evaluated the degree of liver trauma. The diagnostic performance of CEUS and serum liver enzyme measurements was compared with that of CE-MDCT using Spearman’s correlation analysis and Pearson’s correlation analysis, respectively.ResultsSpearman’s rank correlation coefficient between the CEUS-based classification and CE-MDCT was 0.888. The aspartate aminotransferase and lactate dehydrogenase concentrations and the aspartate aminotransferase/alanine aminotransferase ratio were positively correlated with the grade of liver injury; Pearson’s correlation coefficients were 0.664, 0.704, and 0.503, respectively. The gamma-glutamyltransferase concentration had a significantly negative correlation with the grade of liver injury (r = −0.467).ConclusionsCEUS and serum liver enzyme measurement exhibited high consistency with CE-MDCT for both detection and grading of intraparenchymal lesions in blunt liver trauma. These techniques may permit more accurate diagnosis of liver trauma.

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“…The need for non-invasive, cost-effective, and accurate procedures has increased the tendency to use imaging techniques for evaluating patients with BAT. Although a CTscan is the gold standard in abdominal assessment in BAT, some limitations such as x-ray exposure, high costs, possibility of renal poisoning in case of using contrast media, artifact due to patient movement, and need for patient transportation have led to reduced use of CT-scan in such patients (10,11). Alternatively, many studies have shown that ultrasound can be replaced by DPL or CT-scan (12,13); however, there are some evidences that show relying on ultrasound as the only means of assessing BAT victims instead of DPL or CT scan may lead to misdiagnosis (14,15).…”

Section: Introductionmentioning

confidence: 99%

Diagnostic Value of Serial Ultrasound in Blunt Abdominal Trauma

Davoodabadi¹,

Marzban²,

Ghafoor³

et al. 2017

Arch Trauma Res

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Background: Ultrasound has widely been used to assess patients with blunt abdominal trauma and detect free fluid in the abdomen. Nevertheless, different studies reported different false negative for this imaging technique. Objectives: The present study was conducted to evaluate the diagnostic value of the repetitive ultrasound in diagnosis of free intraperitoneal fluid. Methods: In this study, 125 patients with abdominal blunt trauma were recruited prospectively for ultrasound evaluation. Ultrasound and CT-scan were performed for all recruited patients in the study. In case of positive ultrasound or CT-scan (free fluid in the peritoneal cavity), patients underwent surgical operation. In the presence of negative ultrasound and CT-scan, and if the patient was alert and had stable vital signs, then, he/she would undergo exact supervision. In such patients, ultrasound and CT-scan were repeated 12 and 24 hours after admission. If any of the tests were positive, the patient underwent laparotomy. Moreover, if ultrasound and CT-scan examinations were negative 24 hours after admission, the patients with normal laboratory tests were discharged according to the surgeon's decision. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated. Results: Of the 125 patients with abdominal blunt trauma, 90 patients finally underwent laparotomy. Based on the surgical outcome as the gold standard, the initial, 12 hours, and 24 hours sensitivity were measured to be 19.

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Evaluation for intra-abdominal injury in children after blunt torso trauma

Cited by 82 publications

References 23 publications

Paediatric Blunt Torso Trauma: Injury mechanisms, patterns and outcomes among children requiring hospitalisation at the Sultan Qaboos University Hospital, Oman

Paediatric Blunt Torso Trauma: Injury mechanisms, patterns and outcomes among children requiring hospitalisation at the Sultan Qaboos University Hospital, Oman

Effectiveness of contrast-enhanced ultrasound and serum liver enzyme measurement in detection and classification of blunt liver trauma

Diagnostic Value of Serial Ultrasound in Blunt Abdominal Trauma

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