Clinical Pediatric Emergency Medicine
Volume 12, Issue 1 , Pages 2-17 , March 2011

Extending the Focused Assessment With Sonography for Trauma Examination in Children

  • Lana M. Friedman, MD

      Affiliations

    • Division of Pediatric Emergency Medicine, Department of Emergency Medicine, Mount Sinai School of Medicine, New York, NY
    • ,
  • James W. Tsung, MD, MPH

      Affiliations

    • Division of Pediatric Emergency Medicine, Department of Emergency Medicine, Mount Sinai School of Medicine, New York, NY
    • Division of Emergency Ultrasound, Department of Emergency Medicine, Mount Sinai School of Medicine, New York, NY
    • Corresponding Author InformationReprint requests and correspondence: James W. Tsung, MD, MPH, Department of Emergency Medicine, Mount Sinai School of Medicine, 1 Gustave Levy Place, New York, NY 10029.

References 

  1. Centers for Disease Control and Prevention . Ten leading causes of death and injury. Available at http://www.cdc.gov/injury/wisqars/LeadingCauses.htmlAccessed November 1, 2010
  2. Holmes JF, Sokolove PE, Brant WE, et al. Identification of children with intra-abdominal injuries after blunt trauma. Ann Emerg Med. 2002;39:500–509
  3. Isaacman DJ, Scarfone RJ, Kost SI, et al. Utility of routine laboratory testing for detecting intra-abdominal injury in the pediatric trauma patient. Pediatrics. 1993;92:691–694
  4. Soudack M, Epelman M, Maor R, et al. Experience with focused abdominal sonography for trauma in 313 pediatric patients. J Clin Ultrasound. 2004;32:53–61
  5. Green SM, Rothrock SG. Is pediatric trauma really a surgical disease?. Ann Emerg Med. 2002;39:537–540
  6. American College of Surgeons . Advanced Trauma Life Support for Doctors. 7th ed. Chicago, IL: The American College of Surgeons; 2004;
  7. American College of Emergency Physicians . Policy statement. Emergency ultrasound guidelines. Ann Emerg Med. 2009;53:550–570
  8. Holmes JF, Gladman A, Chang CH. Performance of abdominal ultrasonography in pediatric blunt trauma patients: a meta-analysis. J Pediatr Surg. 2007;42:1588–1594
  9. Holmes JF, Brant WE, Bond WF, et al. Emergency department ultrasonography in the evaluation of hypotensive and normotensive children with blunt abdominal trauma. J Pediatr Surg. 2001;36:968–973
  10. Soundappan SV, Holland AJ, Cass DT, et al. Diagnostic accuracy of surgeon-performed focused abdominal sonography (FAST) in blunt paediatric trauma. Injury. 2005;36:970–975
  11. Kristensen JK, Beumann B, Kuhl E. Ultrasonic scanning in the diagnosis of splenic haematomas. Acta Chir Scand. 1971;137:653–657
  12. Filiatrault D, Longpre D, Patriquin H, et al. Investigation of childhood blunt abdominal trauma: a practical approach using ultrasound as the initial diagnostic modality. Pediatr Radiol. 1987;17:373–379
  13. Luks FI, Lemire A, St-Vil D, et al. Blunt abdominal trauma in children: the practical value of ultrasonography. J Trauma. 1993;34:607–610
  14. Coley BD, Mutabagani KH, Martin LC, et al. Focused abdominal sonography for trauma (FAST) in children with blunt abdominal trauma. J Trauma. 2000;48:902–906
  15. Rozycki GS, Ochsner MG, Jaffin JH, et al. Prospective evaluation of surgeons' use of ultrasound in the evaluation of trauma patients. J Trauma. 1993;34:516–526
  16. Rozycki GS, Ochsner MG, Schmidt JA, et al. A prospective study of surgeon-performed ultrasound as the primary adjuvant modality for injured patient assessment. J Trauma. 1995;39:492–498
  17. Han DC, Rozycki GS, Schmidt JA, Feliciano DV. Ultrasound training during ATLS: an early start for surgical interns. J Trauma. 1996;41:208–213
  18. Scalea TM, Rodriguez A, Chiu WC, et al. Focused assessment with sonography for trauma (FAST): results from an international consensus conference. J Trauma. 1999;46:466–472
  19. Heller MB, Mandavia D, Tayal VS, et al. Residency training in emergency ultrasound: fulfilling the mandate. Acad Emerg Med. 2002;9:835–839
  20. Akhtar S, Theodoro D, Gaspari R, et al. Resident training in emergency ultrasound: consensus recommendations from the 2008 Council of Emergency Medicine Residency Directors conference. Acad Emerg Med. 2009;16(Suppl 2):S32–S36
  21. Branney SW, Moore EE, Cantrill SV, et al. Ultrasound based key clinical pathway reduces use of hospital resources for the evaluation of blunt abdominal trauma. J Trauma. 1997;42:1086–1090
  22. Melniker LA, Leibner E, McKenny MG, et al. Randomized controlled trial of point-of-care, limited ultrasonography for trauma in the emergency department: the first sonography outcomes assessment program trial. Ann Emerg Med. 2006;48:227–235
  23. Brenner DJ. Estimating cancer risks from pediatric CT: going from the qualitative to the quantitative. Pediatr Radiol. 2002;32:228–242
  24. Brenner DJ, Ellison CD, Hall EJ, et al. Estimates of the cancer risks from pediatric CT radiation are not merely theoretical. Comment on “point/counterpoint: in x-ray computed tomography, technique factors should be selected appropriate to patient size.. Med Phys. 2001;28:2387–2388
  25. Brenner D, Elliston C, Hall E, Berdon W. Estimated risks of radiation-induced fatal cancer from pediatric CT. AJR Am J Roentgenol. 2001;176:289–296
  26. Faulkner K, Moores BM. Radiation dose and somatic risk from computed tomography. Acta Radiol. 1987;28:483–488
  27. Henneman PL, Marx JA, Moore EE, et al. Diagnostic peritoneal lavage: accuracy in predicting necessary laparatomy following blunt and penetrating trauma. J Trauma. 1990;30:1345–1355
  28. Minarik L, Slim M, Rachlin S, et al. Diagnostic imaging in the follow-up of non-operative management of splenic trauma in children. Pediatr Surg Int. 2002;18:429–431
  29. Cogbill TH, Moore EE, Jurkovich GJ, et al. Nonoperative management of blunt splenic trauma: a multicenter experience. J Trauma. 1989;29:1312–1317
  30. Branney SW, Wolfe RE, Moore EE, et al. Quantitative sensitivity of ultrasound in detecting free intraperitoneal fluid. J Trauma. 1995;39:375–380
  31. Thourani VH, Pettitt BJ, Cooper WA, et al. Validation of surgeon-performed emergency abdominal ultrasonography in paediatric trauma patients. J Pediatr Surg. 1998;33:322–328
  32. Melniker LA. The value of focused assessment with sonography in trauma examination for the need for operative intervention in blunt torso trauma; a rebuttal to “emergency ultrasound-based algorithms for diagnosing blunt abdominal trauma (review)”, from the Cochrane Collaboration. Crit Ultrasound J. 2009;1:73–84
  33. AHRQ . Costs of treating trauma disorders now comparable to medical expenses for heart disease. AHRQ News and Numbers; 2006;Available at http://www.ahrq.gov/news/nn/nn012506.htmAccessed 1/8/11
  34. Rose JS, Levitt MA, Porter J, et al. Does the presence of ultrasound really affect computed tomographic scan use? A prospective randomized trial of ultrasound in trauma. J Trauma. 2001;51:545–550
  35. Stengel D, Bauwens K, Sehouli J, et al. Emergency ultrasound-based algorithms for diagnosing blunt abdominal trauma. Cochrane Database Syst Rev. 2005;CD004446;Last Update: February 18, 2008
  36. Benya EC, Lim-Dunham JE, Landrum O, et al. Abdominal sonography in the examination of children with blunt abdominal trauma. Am J Roentgenol. 2000;174:1613–1616
  37. Meyer DM, Thal ER, Colin D, et al. Computed tomography in the evaluation of children with blunt abdominal trauma. Ann Surg. 1993;217:272–276
  38. Tas F, Ceran C, Atalar MH, et al. The efficacy of ultrasonography in hemodynamically stable children with blunt abdominal trauma: a prospective comparison with computed tomography. Eur J Radiol. 2004;51:91–96
  39. Engelhardt S, Hoyt D, Coimbra R, et al. The 15-year evolution of an urban trauma center: what does the future hold for the trauma surgeon?. J Trauma. 2001;51:633–637
  40. Davies DA, Pearl RH, Ein SH, et al. Management of blunt splenic injury in children: evolution of the nonoperative approach. J Pediatr Surg. 2009;44:1005–1008
  41. Blackbourne LH, Soffer D, McKenney M, et al. Secondary ultrasound examination increases the sensitivity of the FAST exam in blunt trauma. J Trauma. 2004;57:932–938
  42. Henderson SO, Sung J, Mandavia D. Serial abdominal ultrasound in the setting of trauma. J Emerg Med. 2000;18:79–81
  43. Dehmer JJ, Adamson WT. Massive transfusion and blood product use in the pediatric trauma patient. Semin Pediatr Surg. 2010;19:286–291
  44. Brown CV, Foulkrod KH, Sadler HT, et al. Autologous blood transfusion during emergency trauma operations. Arch Surg. 2010;145:690–694
  45. Kendall JL, Faragher J, Hewitt GJ, et al. Emergency department ultrasound is not a sensitive detector of solid organ injury. West J Emerg Med. 2009;10:1–5
  46. Rozycki GS, Knudson MM, Shackford SR, et al. Surgeon-performed bedside organ assessment with sonography after trauma (BOAST): a pilot study from the WTA Multicenter group. J Trauma. 2005;59:1356–1364
  47. Stengel D, Bauwens K, Sehouli J, et al. Discriminatory power of 3.5 MHz convex and 7.5 MHz linear ultrasound probes for the imaging of traumatic splenic lesions. J Trauma. 2001;51:37–43
  48. Tsung JW. Rules for the road: an evidence-based approach to understanding diagnostic test performance of point-of-care ultrasound for pediatric abdominal emergencies. Crit Ultrasound J. 2010;1:101–103
  49. Nance ML, Mahboubi S, Wickstrom M, et al. Pattern of abdominal free fluid following isolated blunt spleen or liver injury in the pediatric patient. J Trauma. 2002;52:85–87
  50. Ma OJ, Mateer JR. Trauma ultrasound examination versus chest radiography in the detection of hemothorax. Ann Emerg Med. 1997;29:312–315
  51. Kirkpatrick AW, Sirois M, Laupland KB, et al. Hand-held thoracic sonography for detecting post-traumatic pneumothoraces: the Extended Focused Assessment with Sonography for Trauma (EFAST). J Trauma. 2004;57:288–295
  52. Lichtenstein DA, Menu Y. A bedside ultrasound sign ruling out pneumothorax in the critically ill: lung sliding. Chest. 1995;108:1345–1348
  53. Lichtenstein D, Meziere G, Biderman P, et al. The comet-tail artifact: an ultrasound sign ruling out pneumothorax. Intensive Care Med. 2000;26:1434–1440
  54. Lichtenstein D, Meziere G, Biderman P, et al. The “lung point”: an ultrasound sign specific to pneumothorax. Intensive Care Med. 2000;26:1434–1440
  55. Lichtenstein DA, Meziere G, Lascols N, et al. Ultrasound diagnosis of occult pneumothorax. Crit Care Med. 2005;33:1231–1238
  56. Knodtson JL, Dort JM, Helmer SD, et al. Surgeon-performed ultrasound for pneumothorax in the trauma suite. J Trauma. 2004;56:527–530
  57. Blaivas M, Lyon M, Duggal S. A prospective comparison of supine chest radiography and bedside ultrasound for the diagnosis of traumatic pneumothorax. Acad Emerg Med. 2005;12:844–849
  58. Nandipati KC, Allamaneni S, Kakarla R, et al. Extended focused assessment with sonography for trauma (EFAST) in the diagnosis of pneumothorax: experience at a community based level 1 trauma center. Injury. 2010;41:862–865
  59. Holmes JF, Brant WE, Bogren HG, et al. Prevalence and importance of pneumothoraces visualized on abdominal computed tomographic scan in children with blunt trauma. J Trauma. 2001;50:516–520
  60. Dulchavsky SA, Henry SE, Moed BR, et al. Advanced ultrasonic diagnosis of extremity trauma: the FASTER examination. J Trauma. 2002;53:28–32
  61. McNeil CR, McManus JG, Mehta S. The accuracy of portable ultrasonography to diagnose fractures in an austere environment. Prehosp Emerg Care. 2009;13:50–52
  62. Sarkisian AE, Khondarian RA, Amirbekian NM, et al. Sonographic screening of mass casualties for abdominal and renal injuries following the 1988 Armenian earthquake. J Trauma. 1991;31:247–250
  63. Ma OJ, Norvell JG, Subramanian S. Ultrasound applications in mass casualties and extreme environments. Crit Care Med. 2007;35:S275–S279
  64. Spencer JK, Adler RS. Utility of portable ultrasound in a community in Ghana. J Ultrasound Med. 2008;27:1735–1743
  65. Otto C, Hamilton DR, Levine BD, et al. Into thin air: extreme ultrasound on Mt Everest. Wilderness Environ Med. 2009;20:283–289
  66. Sutherland AI, Morris DS, Owen CG, et al. Optic nerve sheath diameter, intracranial pressure and acute mountain sickness on Mount Everest: a longitudinal cohort study. Br J Sports Med. 2008;42:183–188
  67. Sargsyan AE, Hamilton DR, Jones JA, et al. FAST at MACH 20: clinical ultrasound aboard the International Space Station. J Trauma. 2005;58:35–39
  68. Kwon D, Bouffard JA, van Holsbeeck M, et al. Battling fire and ice: remote guidance ultrasound to diagnose injury on the International Space Station and the ice rink. Am J Surg. 2007;193:417–420
  69. Weinberg ER, Tunik MG, Tsung JW. Accuracy of clinician-performed point-of-care ultrasound for the diagnosis of fractures in children and young adults. Injury. 2010;41:862–868
  70. Hubner U, Schlicht W, Outzen S, et al. Ultrasound in the diagnosis of fractures in children. J Bone Joint Surg Br. 2000;82:1170–1173
  71. Moritz JD, Berthold LD, Soenksen SF, et al. Ultrasound in diagnosis of fractures in children: unnecessary harassment of useful addition to x-ray?. Ultraschall Med. 2008;28:267–274
  72. Chen L, Kim Y, Moore CL. Diagnosis and guided reduction of forearm fractures in children using bedside ultrasound. Pediatr Emerg Care. 2007;23:528–531
  73. Patel DD, Blumberg S, Crain EF. The utility of bedside ultrasonography in identifying fractures and guiding fracture reduction in children. Pediatr Emerg Care. 2009;25:221–225
  74. Marshburn TH, Legome E, Sargsyan A, et al. Goal-directed ultrasound in the detection of long-bone fractures. J Trauma. 2004;57:329–332
  75. Steiner S, Riebel T, Nazarenko O, et al. Skull injury in childhood: comparison of sonography with conventional x-ray and CT. Rofo. 1996;165:353–358
  76. Tsung JW, Blaivas M, Cooper A, et al. A rapid noninvasive method of detecting elevated intracranial pressure using bedside ocular ultrasound: application to 3 cases of head trauma in the pediatric emergency department. Pediatr Emerg Care. 2005;21:94–98
  77. Le A, Hoehn ME, Smith ME, et al. Bedside sonographic measurement of optic nerve sheath diameter as a predictor of increased intracranial pressure in children. Ann Emerg Med. 2009;53(6):785–791
  78. McAuley D, Paterson A, Sweeney L. Optic nerve sheath ultrasound in the assessment of paediatric hydrocephalus. Childs Nerv Syst. 2009;25:77–84
  79. Blaivas M, Tsung JW. Point-of-care sonographic detection of left endobronchial main stem intubation and obstruction versus endotracheal intubation. J Ultrasound Med. 2008;27:785–789
  80. Tsung JW, Blaivas M. Dynamic scanning in the transverse plane for ultrasound-guided fracture reduction. Pediatr Emerg Care. 2009;25:805
  81. Shackford SR, Rogers FB, Osler TM, et al. Focused abdominal sonogram for trauma: the learning curve of nonradiologist clinicians in detecting hemoperitoneum. J Trauma. 1999;46:553–562
  82. Yanagawa Y, Nishi K, Sakamoto T, et al. Early diagnosis of hypovolemic shock by sonographic measurement of inferior vena cava in trauma patients. J Trauma. 2005;58:825–829
  83. Pershad J, Myers S, Plouman C, et al. Bedside limited echocardiography by the emergency physician is accurate during evaluation of the critically ill patient. Pediatrics. 2004;114:e667–e671
  84. McGahan JP, Horton S, Gerscovich EO, et al. Appearance of solid organ injury with contrast-enhanced sonography in blunt abdominal trauma: preliminary experience. AJR Am J Roentgenol. 2006;187:658–666
  85. Poletti PA, Platon A, Becker CD, et al. Blunt abdominal trauma: does the use of a second generation sonographic contrast agent help to detect solid organ injury?. AJR Am J Roentgenol. 2004;183:1293–1301
  86. Valentino M, Ansaloni L, Catena F, et al. Contrast-enhanced ultrasonography in blunt abdominal trauma: considerations after 5 years of experience. Radiol Med. 2009;114:1080–1093
  87. Catalano O, Luca A, Barozzi L, et al. CEUS in abdominal trauma: multi-center study. Abdom Imaging. 2009;34:225–234
  88. Catalano O, Lobianco R, Raso MM, et al. Blunt hepatic trauma: evaluation with contrast-enhanced and clinical application. J Ultrasound Med. 2005;24:299–310
  89. Catalano O, Lobianco R, Sandomenico F, et al. Splenic trauma: evaluation with contrast-specific sonography and a second-generation contrast medium: preliminary experience. J Ultrasound Med. 2003;22:467–477
  90. Noble VE, Blaivas M, Blankenship R, et al. Decision rule for imaging utilization in blunt abdominal trauma—where is ultrasound?. Ann Emerg Med. 2010;55:487–489
  91. Oldenburg A, Homann J, Skrok J, et al. Imaging of paediatric splenic injury with contrast-enhanced ultrasonography. Pediatr Radiol. 2004;34:351–354
  92. Valentino M, Galloni SS, Rimondi MR, et al. Contrast-enhanced ultrasound in non-operative management of pancreatic injury in childhood. Pediatr Radiol. 2006;36:558–560
  93. Valentino M, Serra C, Pavlica P, et al. Blunt abdominal trauma: diagnostic performance of contrast-enhanced US in children—initial experience. Radiology. 2008;246:903–909
  94. Blaivas M, Lyon M, Brannam L, et al. Feasibility of FAST examination performance with ultrasound contrast. J Emerg Med. 2005;29:307–311
  95. Stylianos S. APSA Trauma Committee. Evidence-based guidelines for resource utilization in children with isolated spleen or liver injury. J Pediatr Surg. 2000;35:164–169
  96. Tayal VS, Weekes A, Jayarama K. Biplanar and 3-dimensional ultrasound in emergency ultrasound applications. J Ultrasound Med. 2009;28:S166;[Abst]

PII: S1522-8401(10)00098-4

doi: 10.1016/j.cpem.2010.12.007

Clinical Pediatric Emergency Medicine
Volume 12, Issue 1 , Pages 2-17 , March 2011

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