Ultrasound for children with abdominal trauma
Despite evidence showing that the routine use of sonography in hospital emergency departments can safely improve care for adults when evaluating for possible abdominal trauma injuries, researchers at UC Davis Medical Center could not identify any significant improvements in care for pediatric trauma patients. The findings, which resulted from a randomized clinical study involving 925 children with blunt torso trauma who were evaluated in the emergency department at the medical centre, showed no difference in important clinical outcomes. The outcomes assessed were developed for the study mainly based on previous research in injured adults.
The UC Davis team investigated the Focused Assessment with Sonography for Trauma (FAST) to determine whether the use of the FAST examination could safely lead to a decrease in the use of computed tomography (CT) scans for children, and other outcomes. FAST is a bedside ultrasound examination using a portable ultrasound machine. It has not been routinely used in the initial emergency department evaluations of injured children. CT scans represent the “gold standard” in diagnostic imaging for clinicians, including the identification of intra-abdominal injuries, but they also pose a greater radiation risk for children than they do for adults.
“A lot of our work has looked at the appropriate use of CT scans in injured patients,” said James Holmes, professor of emergency medicine and the study’s lead author. “At least in the adult trauma population, there’s evidence that you can use ultrasound to safely decrease CT use. One of the big questions has been whether that holds true for children, too.”
Holmes and his colleagues identified a study cohort of hemodynamically-stable children who presented in the emergency department at UC Davis Medical Center with blunt torso injuries resulting from mechanisms such as motor vehicle collisions and falls greater than 20 feet (6m). Four hundred and sixty patients were randomized to the FAST group and 465 to the no-FAST group, who received the same standard trauma evaluations but without ultrasound.
As in previous studies, the researchers wanted to determine whether the FAST protocol could significantly decrease the length-of-stay for patients in the emergency department, reduce hospital billing charges and still identify injuries when compared to patients who did not receive a FAST examination.
“We were surprised that the routine use of FAST did not show any significant differences,” said Nathan Kuppermann, professor and chair of emergency medicine at UC Davis and the study’s senior author and co-principal investigator. “The use of FAST compared with our standard trauma care did not decrease CT scan use, improve resource use, emergency department length-of-stay, safety or hospital charges.”
UC Davis Health http://tinyurl.com/yceftcp4
