ULTRASOUND IS AN EFFECTIVE TRIAGE TOOL TO EVALUATE BLUNT ABDOMINAL-TRAUMA IN THE PEDIATRIC POPULATION

Background: Although computed tomography has been considered the diagn ostic modality of choice for pediatric patients with blunt abdominal t rauma (BAT), it is costly, time-consuming, requires sedation, and may be associated with complications in young children, Abdominal ultrason ography (US) is a promising modality in the evaluation of BAT that is quick, noninvasive, repeatable, and cost-effective. We hypothesized th at emergency department US, performed by trauma surgeons, is a useful triage tool for pediatric BAT that reduces the need for computed tomog raphy. Methods: The 230 children (<18 years old) with suspected BAT we re initially evaluated with US in the emergency department by surgeons , Subsequent computed tomographic scan or exploratory laparotomy was p erformed as indicated by the key clinical pathway. Results: Twelve chi ldren (5.2%) had documented intra-abdominal injuries, All five injured children with significant intraperitoneal fluid were identified by US . Of the seven patients who had intra-abdominal injury not detected by US, six sustained solid organ injuries that were managed nonoperative ly, Extrapolated reductions in hospital charges due to the decreased n umber of computed tomographic scans total $130,000. Conclusions: Using US as a triage tool may dramatically reduce the cost of pediatric BAT evaluation while being able to quickly identify significant intraperi toneal fluid that requires further evaluation and possible laparotomy.