Diagnostic Management in Paediatric Blunt Abdominal Trauma A Systematic Review with Metaanalysis

Objective: The objective of this systematic review was to investigate the diagnostic management in paediatric blunt abdominal injuries. Methods: A literature research was performed using following sources: MEDLINE, Embase and Cochrane. Where it was possible a meta-analysis was performed. Furthermore the level of evidence for all publications was assigned. Results: Indicators for intraabdominal injury (IAI) were elevated liver transaminases, abnormal abdominal examinations, low systolic blood pressure, reduced haematocrit and microhematuria. Detecting IAI with focused assessment with sonography for trauma (FAST) had an overall sensitivity of 56.5%, a specificity of 94.68%, a positive likelihood ratio of 10.63 and a negative likelihood ratio of 0.46. The accuracy was 84.02%. Among haemodynamically unstable children the sensitivity and specificity were 100%. The overall prevalence of IAI and negative CT was 0.19%. The NPV of abdominal CT for diagnosing IAI was 99.8%. The laparotomy rate in patients with isolated intraperitoneal fluid (IIF) in one location was 3.48% and 56.52% in patients with IIF in more than one location. Conclusions: FAST as an isolated tool in the diagnostics after blunt abdominal injury is very uncertain, because of the modest sensitivity. Discharging children after blunt abdominal trauma with a negative abdominal CT scan seems to be safe. When IIF is detected on CT scan, it depends on the number of locations involved. If IIF is found only in 1 location, IAI is uncommon, while IIF in two or more locations results in a high laparotomy rate.