USE OF ABDOMINAL ULTRASONOGRAPHY TO ASSESS PEDIATRIC SPLENIC TRAUMA -POTENTIAL PITFALLS IN THE DIAGNOSIS

Objective The purpose of this study was to evaluate the accuracy of ab dominal ultrasonography (US) for screening and grading pediatric splen ic injury. Summary Background Data The use of abdominal US has increas ed rapidly as a method of evaluating organ damage after blunt abdomina l trauma, Despite US's increasing use? little is known about its accur acy in children with splenic injury. Methods Children (N = 32) sufferi ng blunt abdominal trauma who were diagnosed with splenic injury by co mputerized tomography (CT) scan prospectively were enlisted in this st udy. Degree of splenic injury was evaluated by both CT and US. The ult rasounds were evaluated by an initial reading as well as by a radiolog ist who was blinded as to the results of the CT. Results Twelve (38%) of the 32 splenic injuries found on CT were missed completely on the i nitial reading of the US. When the ultrasounds were graded in a blinde d fashion, 10 (31%) of the splenic lacerations were missed and 17 (53% ) were downgraded. Seven (22%) of the 32 splenic fractures were not as sociated with any free intraperitoneal fluid on the CT scan. Conclusio ns This study has shown that US has a low level of sensitivity (62% to 78%) in detecting splenic injury and downgrades the degree of injury in the majority of cases. Reliance on free intraperitoneal fluid may b e inaccurate because not ail patients with splenic injury have free in tra-abdominal fluid, Based on these findings? US may be of limited use in the initial assessment, management, and follow-up of pediatric spl enic trauma.