Pediatric Abdominal Trauma Ultrasound Holds No Benefit

A new study concludes that in children with blunt torso trauma, focused assessment with sonography does not improve clinical care, reduce computed tomography (CT) scans, or help identify missed intra-abdominal injuries.

Researchers at the University of California Davis (UCD; Sacramento, USA) conducted a randomized clinical study involving 925 hemodynamically stable children and adolescents with blunt torso trauma who were evaluated in the emergency department (ED). Patients were assigned to either standard trauma evaluation or to a focused assessment with sonography for trauma (FAST) examination by the ED physician. Outcomes included rate of abdominal computed tomographic (CT) scans in the ED, missed intra-abdominal injuries, ED length of stay, and hospital charges.

A total of 50 patients were diagnosed with intra-abdominal injuries. In the standard trauma evaluation group, 254 of 465 (54.6%) children underwent an abdominal CT; in the FAST group, 241 of 460 (52.4%) children had one. Overall, one case of missed intra-abdominal injury occurred in a patient in the FAST group and none in the control group. The mean ED length of stay was 6.03 hours in the FAST group and 6.07 hours in the standard care group. Median hospital charges were USD 46,415 in the FAST group and USD 47,759 in the standard care group. The study was published on June 13, 2017, in the Journal of the American Medical Association (JAMA).

“While ultrasound appears to have the potential to decrease CT use in children, we wanted to determine whether it actually worked in practice,” said senior author Professor Nathan Kuppermann, MD, chair of emergency medicine at UCD. “In all of the cases where the risk was identified as low, but where CT scans were ordered anyway, we didn’t find one patient who actually had an intra-abdominal injury.”

Guidelines for FAST examination published by the American Institute of Ultrasound in Medicine (AIUM) and the American College of Emergency Physicians (ACEP) recommend evaluation of the torso for free fluid suggesting injury to the peritoneal, pericardial, and pleural cavities, particularly in cases of trauma; examination of the subxiphoid window of the heart to denote pericardial fluid; and evaluation of the lungs to identify pneumothorax.

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