UMEM Educational Pearls

Title: Clinically Ambiguous Pediatric Abdominal Trauma: Go beyond the FAST!

Keywords: Pediatric, Trauma, Ultrasound, Abdomen, International (PubMed Search)

Posted: 11/27/2013 by Andrea Tenner, MD
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General Information:

Abdominal injuries account for 10% of trauma deaths in patients aged 5–14 years. The burden of injury is greatest in low- and middle-income countries, where 95% of all childhood injury deaths occur.

Relevance to the EM Physician:

In children with abdominal trauma, the clinical picture does not always distinguish who can be managed conservatively versus aggressively.
Also, unlike in adults, 30% of solid organ injury in children presents without free fluid on ultrasound. (In a 107-patient study, ultrasound had a sensitivity of 55% as compared to CT).
A study of 497 stable peds patients found that the combination of FAST and LFT results were 88% sensitive and 98% specific (positive predictive value=93.7%, negative predictive value=96.1%) for intra-abdominal injury in pediatrics.

Bottom Line: In a stable pediatric abdominal trauma victim, combined FAST and LFT results are an effective screening tool to evaluate for intra-abdominal injury.

University of Maryland Section of Global Emergency Health

Author: Tristan Meador, MD

References

Kenefake et al, Pediatric Emergency Medicine Nuances in Pediatric Truama. Emergency Medicine Clinics of North America, August 2013, 31;3:627-652

Krug E. Injury: a leading cause of the global burden of disease. Geneva: World Health Organization; 1999 (WHO/HSC/PVI/99.11).

Retzlaff et al, Is sonography reliable for the diagnosis of pediatric blunt abdominal trauma. J of Ped Surg 2010; 45: 912-915

Sola et al, Pediatric FAST and Elevated Liver Transaminases: An Effective Screening Tool in Blunt Abdominal Truama. J of Surgical Research 2009; 157;1: 103-107