THE PLACE OF ULTRASONOGRAPHIC EXAMINATION IN THE INITIAL EVALUATION OF CHILDREN SUSTAINING BLUNT ABDOMINAL-TRAUMA

Physical examination is stated to be inaccurate in detecting organ injury after blunt abdominal trauma (BAT) in children and the use of diagnostic peritoneal lavage (DPL) and computed tomography (CT) are suggested. However, assessments for the need of such diagnostic aids are quite subjective. The records of 109 patients initially evaluated by ultrasonography (US) for BAT were reviewed to determine whether an easily performed, quick method such as US could be used for selection. US showed free intraperitoneal fluid (FIF) in 30 patients (27.5%) and retroperitoneal injury in 5 patients (4.5%). Of the 30 patients with FIF, 23 patients (76.7%) were treated conservatively but 7 (23.3%) required laparotomy. The correlation between the amount of FIF and the requirement for operative treatment was statistically significant (P<.01). Of the 74 patients (68%) without FIF, clinical outcome was uneventful in 72 (97.3%) while 2 patients (2.7%) required laparotomy for peritonitis and ileal perforations were encountered. The present study has showed that US is inaccurate in detecting solid intraabdominal injuries; however, it is reliable in detecting FIF produced as a result of intraabdominal organ injuries and retroperitoneal organ injuries. We suggest the use of US as the objective initialevaluation method of choice on a routine basis. © 1993 W.B. Saunders Company. All rights reserved.