Pediatric emergency medicine trisk 3186 3186

While ultrasound screening (FAST) of the abdomen has been routinely utilized in adult trauma patients for many years with excellent sensitivity and specificity, the utility of FAST in children is a source of much debate Review of several studies of adults with blunt abdominal trauma suggests that the immediate use of FAST may reduce the use of CT for unstable patients with a positive ultrasound finding The preponderance of recent literature suggests that FAST (in unstable patients) may support a decision to proceed to laparotomy without the need to undergo further testing (diagnostic therapeutic lavage or CT) In the unstable patient, free fluid points toward the need for operative intervention, whereas in the stable patient, further evaluation with CT scan is indicated DIAGNOSTIC IMAGING FOR ABDOMINAL TRAUMA Goals of Treatment Radiographic evaluation of children with abdominal trauma may include plain radiographs, contrast studies, ultrasound, and CT CT scanning of the abdomen after blunt trauma is the standard of care when suspicion of intra-abdominal injury exists Intravenous contrast is recommended to obtain the greatest amount of information from a single study Importantly, not all trauma surgeons or radiologists agree that oral contrast is required for all cases, especially if time is limited If a nasogastric or orogastric tube is in place, it should be withdrawn temporarily into the esophagus to avoid an artifact from its radiopaque marker Although CT is the most common technique used in childhood trauma, the surgeon’s decision to proceed to laparotomy or laparoscopy may be based more on the clinical status of the child than on the radiologic findings Abdominal CT is considered the most sensitive diagnostic tool, although FAST may provide important data early in the course of the management of a child with suspected intra-abdominal injuries ( Fig 103.2 )