Emergency department ultrasonography in the evaluation of hypotensive and normotensive children with blunt abdominal trauma

James F Holmes Jr, William E. Brant, William F. Bond, Peter E. Sokolove, Nathan Kuppermann

Research output: Contribution to journalArticle

77 Citations (Scopus)

Abstract

Purpose: The aim of this study was to evaluate the accuracy of emergency department (ED) ultrasound scan in identifying which children with blunt torso trauma have intraperitoneal fluid associated with intraabdominal injuries (IAI). Methods: The authors conducted a prospective, observational study of children (<16 years old) with blunt trauma who presented to a level 1 trauma center over a 29-month period and underwent abdominal ultrasound scan while in the ED. Ultrasound examinations were ordered at the discretion of the trauma surgeons or ED physicians caring for the patients, performed by trained sonographers, and interpreted at the time of the ultrasound. Ultrasound examinations were interpreted solely for the presence or absence of intraperitoneal fluid. Hypotension was defined as ≥ 1 standard deviation below the age-adjusted mean. Patients underwent follow-up to identify those with intraperitoneal fluid and IAI. Results: A total of 224 pediatric blunt trauma patients had ultrasound scan performed and were enrolled. Thirty-three patients had IAI with intraperitoneal fluid, and ultrasound scan was positive in 27. The accuracy of abdominal ultrasound for detecting intraperitoneal fluid associated with IAI was sensitivity, 82% (95% confidence interval [Cl] 65% to 93%); specificity, 95% (95% Cl 91% to 97%); positive predictive value, 73% (95% Cl 56% to 86%); and negative predictive value, 97% (95% Cl 93% to 99%). In the 13 patients who were hypotensive, ultrasound scan correctly identified intraperitoneal fluid in all 7 patients (sensitivity 100%) with IAI, and hemoperitoneum and was negative in all 6 patients (specificity 100%) who did not have hemoperitoneum. Nine patients had IAI without intraperitoneal fluid, and ultrasound scan result was negative for fluid in all 9. Conclusions: ED abdominal ultrasound scan used solely for the detection of intraperitoneal fluid in pediatric blunt trauma patients has a modest accuracy. Ultrasonography has the best test performance in those children who are hypotensive and should be obtained early in the ED evaluation of these patients.

Original languageEnglish (US)
Pages (from-to)968-973
Number of pages6
JournalJournal of Pediatric Surgery
Volume36
Issue number7
DOIs
StatePublished - 2001

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Hospital Emergency Service
Ultrasonography
Wounds and Injuries
Hemoperitoneum
Pediatrics
Torso
Trauma Centers
Hypotension
Observational Studies
Prospective Studies
Confidence Intervals
Physicians

Keywords

  • Blunt abdominal trauma
  • Pediatric abdominal injury
  • Ultrasound

ASJC Scopus subject areas

  • Surgery

Cite this

Emergency department ultrasonography in the evaluation of hypotensive and normotensive children with blunt abdominal trauma. / Holmes Jr, James F; Brant, William E.; Bond, William F.; Sokolove, Peter E.; Kuppermann, Nathan.

In: Journal of Pediatric Surgery, Vol. 36, No. 7, 2001, p. 968-973.

Research output: Contribution to journalArticle

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abstract = "Purpose: The aim of this study was to evaluate the accuracy of emergency department (ED) ultrasound scan in identifying which children with blunt torso trauma have intraperitoneal fluid associated with intraabdominal injuries (IAI). Methods: The authors conducted a prospective, observational study of children (<16 years old) with blunt trauma who presented to a level 1 trauma center over a 29-month period and underwent abdominal ultrasound scan while in the ED. Ultrasound examinations were ordered at the discretion of the trauma surgeons or ED physicians caring for the patients, performed by trained sonographers, and interpreted at the time of the ultrasound. Ultrasound examinations were interpreted solely for the presence or absence of intraperitoneal fluid. Hypotension was defined as ≥ 1 standard deviation below the age-adjusted mean. Patients underwent follow-up to identify those with intraperitoneal fluid and IAI. Results: A total of 224 pediatric blunt trauma patients had ultrasound scan performed and were enrolled. Thirty-three patients had IAI with intraperitoneal fluid, and ultrasound scan was positive in 27. The accuracy of abdominal ultrasound for detecting intraperitoneal fluid associated with IAI was sensitivity, 82{\%} (95{\%} confidence interval [Cl] 65{\%} to 93{\%}); specificity, 95{\%} (95{\%} Cl 91{\%} to 97{\%}); positive predictive value, 73{\%} (95{\%} Cl 56{\%} to 86{\%}); and negative predictive value, 97{\%} (95{\%} Cl 93{\%} to 99{\%}). In the 13 patients who were hypotensive, ultrasound scan correctly identified intraperitoneal fluid in all 7 patients (sensitivity 100{\%}) with IAI, and hemoperitoneum and was negative in all 6 patients (specificity 100{\%}) who did not have hemoperitoneum. Nine patients had IAI without intraperitoneal fluid, and ultrasound scan result was negative for fluid in all 9. Conclusions: ED abdominal ultrasound scan used solely for the detection of intraperitoneal fluid in pediatric blunt trauma patients has a modest accuracy. Ultrasonography has the best test performance in those children who are hypotensive and should be obtained early in the ED evaluation of these patients.",
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AB - Purpose: The aim of this study was to evaluate the accuracy of emergency department (ED) ultrasound scan in identifying which children with blunt torso trauma have intraperitoneal fluid associated with intraabdominal injuries (IAI). Methods: The authors conducted a prospective, observational study of children (<16 years old) with blunt trauma who presented to a level 1 trauma center over a 29-month period and underwent abdominal ultrasound scan while in the ED. Ultrasound examinations were ordered at the discretion of the trauma surgeons or ED physicians caring for the patients, performed by trained sonographers, and interpreted at the time of the ultrasound. Ultrasound examinations were interpreted solely for the presence or absence of intraperitoneal fluid. Hypotension was defined as ≥ 1 standard deviation below the age-adjusted mean. Patients underwent follow-up to identify those with intraperitoneal fluid and IAI. Results: A total of 224 pediatric blunt trauma patients had ultrasound scan performed and were enrolled. Thirty-three patients had IAI with intraperitoneal fluid, and ultrasound scan was positive in 27. The accuracy of abdominal ultrasound for detecting intraperitoneal fluid associated with IAI was sensitivity, 82% (95% confidence interval [Cl] 65% to 93%); specificity, 95% (95% Cl 91% to 97%); positive predictive value, 73% (95% Cl 56% to 86%); and negative predictive value, 97% (95% Cl 93% to 99%). In the 13 patients who were hypotensive, ultrasound scan correctly identified intraperitoneal fluid in all 7 patients (sensitivity 100%) with IAI, and hemoperitoneum and was negative in all 6 patients (specificity 100%) who did not have hemoperitoneum. Nine patients had IAI without intraperitoneal fluid, and ultrasound scan result was negative for fluid in all 9. Conclusions: ED abdominal ultrasound scan used solely for the detection of intraperitoneal fluid in pediatric blunt trauma patients has a modest accuracy. Ultrasonography has the best test performance in those children who are hypotensive and should be obtained early in the ED evaluation of these patients.

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