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Predicting the Need for Laparotomy in Pediatric Trauma Patients on the Basis of the Ultrasound Score

Ong, Adrian W. MD; McKenney, Mark G. MD; McKenney, Kimberley A. MD; Brown, Margaret RN, MSN; Namias, Nicholas MD; MaCloud, Jana MD, MSc, FRCS(C); Cohn, Stephen M. MD

The Journal of Trauma: Injury, Infection, and Critical Care: March 2003 - Volume 54 - Issue 3 - p 503-508
doi: 10.1097/01.TA.0000051587.50251.3D

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.

From the Departments of Surgery (A.W.O., M.G.M., M.B., N.N., J.M., S.M.C.) and Radiology (K.A.M.), University of Miami School of Medicine, Miami, Florida.

Submitted for publication August 14, 2001.

Accepted for publication November 26, 2002.

This work was scheduled for a poster presentation at the 61st Annual Meeting of the American Association for the Surgery of Trauma, which was canceled because of the terrorist attacks of September 11, 2001.

Address for reprints: Adrian W. Ong, MD, Department of Surgery, Division of Trauma/Critical Care, Allegheny General Hospital, 320 East North Avenue, Pittsburgh, PA 15212; email:

© 2003 Lippincott Williams & Wilkins, Inc.