Initial evaluation of children sustaining blunt abdominal trauma: ultrasonography vs. diagnostic peritoneal lavage.
Academic Article
Overview
abstract
A prospective clinical study was performed to compare ultrasonography (US) with a modality having 96-99% accuracy like diagnostic peritoneal lavage (DPL) to find the accuracy of US in the initial evaluation of children sustaining blunt abdominal trauma (BAT). Sixty-eight children with BAT were initially evaluated by US, then DPL. All patients with pathologic US findings underwent computerized tomographic examination before DPL to confirm the pathologies. Through US examination free intraperitoneal fluid (FIF) was present in eleven, absent in 57 patients. DPL was positive in ten, negative in 58 patients. Sensitivity, specificity, negative predictive value, positive predictive value and efficiency of US were 100, 98.3, 100, 91 and 98.5 respectively. US detected intraperitoneal solid organ injuries in eleven patients, but DPL was positive in only ten of these patients. While US detected renal injuries in six patients and intrapleural fluid in two patients, DPL was positive in only two of these patients as a result of concomitant intraperitoneal solid organ injuries with FIF. The present study has shown that US can detect FIF with a high rate of accuracy comparable to DPL in children. In addition, US has advantages over DPL in the detection of intraperitoneal organ injuries with or without concomitant FIF, retroperitoneal injuries and intrathoracic injuries. Thus US is thought to be superior to DPL and recommended as a routine first choice screening tool in the initial evaluation of children sustaining BAT.
