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The role of point-of-care ultrasound in the emergent care of ill and injured pediatric patients continues to evolve and mature. Ultrasound technology is ideally suited for infants and children as it allows real-time visualization of anatomic structures without causing pain, requiring sedation, or exposing developing tissues to ionizing radiation.
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There are numerous indications for emergency ultrasound common to both adult and pediatric emergency care. This has led to a greater understanding of the differences that exist when the same applications are used for both pediatric and adult patients. In addition, the functionality of emergency ultrasound has been further expanded by recent innovation and the development of several pediatric-specific applications.
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Trauma remains one of the leading causes of morbidity and mortality in children. In the United States, traumatic injuries result in hospital admission for approximately 600,000 children each year.1 In the pediatric age group, blunt trauma is more prevalent than penetrating trauma, and 20–30% of pediatric trauma cases involve the abdomen.2
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The history and physical examination form the foundation of the patient evaluation; however, they may be difficult to obtain in children who have altered mental status, CNS trauma, or distracting injuries. In one study of children with blunt abdominal trauma, an initial physical examination was considered reliable in only 41% of cases.3 Furthermore, the exam may be misleading in up to 45% of injured children.4,5
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The use of ultrasound in pediatric trauma with the focused assessment with sonography for trauma (FAST) examination has increased over the past decade, but it has not been as well accepted or widely used as it has for adult trauma care. In a survey of general emergency physicians, pediatric emergency physicians, and trauma surgeons, 91% of the respondents considered abdominal ultrasound to be “somewhat to extremely useful.”6 However, with regard to pediatric trauma patients, 73% of all respondents considered abdominal ultrasound to be useful, while only 57% of pediatric emergency physicians considered it so. Furthermore, only 14% of pediatric emergency physicians routinely use abdominal ultrasound for evaluation of their trauma patients.6
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Numerous advantages exist for using ultrasound in pediatric trauma, mirroring its benefits in adult trauma (see Chapter 5, “Trauma”). In pediatrics, limiting the exposure of ionizing radiation is especially appealing.7 The results of a large prospective multicenter trial were recently reported, and showed that pediatric trauma patients with a low-to-moderate clinical suspicion for intra-abdominal injury were significantly less likely to undergo abdominal CT scanning if they underwent a FAST exam.8
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Clinical Considerations
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The 1980s saw a transition away from diagnostic peritoneal lavage toward the use of abdominal CT. CT is still the most commonly used modality in evaluating pediatric abdominal injuries.9–18 The primary advantage of CT is that it accurately and reliably identifies and characterizes most intraperitoneal and retroperitoneal injuries. A major disadvantage of CT ...