Predicting the need for laparotomy in pediatric trauma patients on the basis of the ultrasound score

Adrian W. Ong, Mark G. McKenney, Kimberley A. McKenney, Margaret Brown, Nicholas Namias, Jana MaCloud, Stephen M. Cohn

Research output: Contribution to journalArticle

27 Scopus citations

Abstract

Background It is possible to quantify the amount of hemoperitoneum seen on focused assessment with sonography for trauma (FAST) using a simple scoring system that had previously been shown to correlate with the need for subsequent laparotomy in adults. A score of 3 or greater was shown to be highly accurate in predicting the need for laparotomy. We hypothesized that this scoring system might also predict the need for laparotomy in pediatric trauma patients. Methods We retrospectively reviewed all records for patients 15 years and younger who underwent FAST after blunt trauma. A “positive” ultrasound examination was defined as one containing free intraperitoneal fluid with or without solid organ injury. The ultrasound score (USS) was defined as the depth of the deepest pocket of fluid collection measured in centimeters plus the number of additional spaces where fluid was seen. Results Thirty-eight (19.6%) of 193 patients who had FAST performed had positive ultrasound examinations. Thirty-seven patients with complete records were analyzed. There were no differences between patients with a USS ≤ 3.0 and those with a USS > 3.0 in terms of admission pulse, Glasgow Coma Scale score, Injury Severity Score, or the proportion of patients who were initially hypotensive. One of 22 patients with a USS ≤ 3.0 required therapeutic laparotomy versus 8 of 15 patients with a USS > 3.0 (p = 0.002). For a USS > 3.0, sensitivity, specificity, and accuracy in predicting therapeutic laparotomy were 89%, 75%, and 78%, respectively. Conclusion Ultrasound quantification of hemoperitoneum by a simple scoring system may serve as a useful adjunct to traditional clinical parameters in predicting the need for subsequent laparotomy in pediatric patients. Prospective validation with a larger study is required.

Original languageEnglish (US)
Pages (from-to)503-508
Number of pages6
JournalJournal of Trauma
Volume54
Issue number3
DOIs
StatePublished - Mar 2003

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Keywords

  • Focused assessment with sonography for trauma
  • Hemoperitoneum
  • Laparotomy
  • Pediatric trauma patients

ASJC Scopus subject areas

  • Surgery
  • Critical Care and Intensive Care Medicine

Cite this

Ong, A. W., McKenney, M. G., McKenney, K. A., Brown, M., Namias, N., MaCloud, J., & Cohn, S. M. (2003). Predicting the need for laparotomy in pediatric trauma patients on the basis of the ultrasound score. Journal of Trauma, 54(3), 503-508. https://doi.org/10.1097/01.TA.0000051587.50251.3D