Francesco Pegoraro1, Giulia Giusti2, Martina Giacalone2, Niccolò Parri3. 1. Department of Health Science, University of Florence, Florence, Italy. 2. Department of Emergency Medicine and Trauma Center, Meyer University Children's Hospital, Florence, Italy. 3. Department of Emergency Medicine and Trauma Center, Meyer University Children's Hospital, Florence, Italy. niccolo.parri@meyer.it.
Abstract
PURPOSE: Intra-abdominal injury is a major cause of morbidity in children. Computed tomography (CT) is the reference standard for the evaluation of hemodynamically stable abdominal trauma. CT has an increased risk of long-term radiation induced malignancies and a possible risk associated with the use of iodinated contrast media. Contrast-enhanced ultrasound (CEUS) might represent an alternative to CT in stable children with blunt abdominal trauma (BAT). Nonetheless, CEUS in pediatrics remains limited by the lack of strong evidence. The purpose of this study was to offer a systematic review on the use of CEUS in pediatric abdominal trauma. METHODS: Electronic search of PubMed, EMBASE and Cochrane databases of studies investigating CEUS for abdominal trauma in children. The risk of bias was assessed using the ROBINS-I tool. RESULTS: This systematic review included 7 studies. CEUS was performed with different ultrasound equipment, always with a curvilinear transducer. Six out of seven studies used a second-generation contrast agent. No immediate adverse reactions were reported. The dose of contrast agent and the scanning technique varied between studies. All CEUS exams were performed by radiologists, in the radiology department or at the bedside. No standard training was reported to become competent in CEUS. The range of sensitivity and specificity of CEUS were 85.7 to 100% and 89 to 100%, respectively. CONCLUSION: CEUS appears to be safe and accurate to identify abdominal solid organ injuries in children with BAT. Further research is necessary to assess the feasibility of CEUS by non-radiologists, the necessary training, and the benefit-cost ratio of CEUS as a tool to potentially reduce CT scans.
PURPOSE: Intra-abdominal injury is a major cause of morbidity in children. Computed tomography (CT) is the reference standard for the evaluation of hemodynamically stable abdominal trauma. CT has an increased risk of long-term radiation induced malignancies and a possible risk associated with the use of iodinated contrast media. Contrast-enhanced ultrasound (CEUS) might represent an alternative to CT in stable children with blunt abdominal trauma (BAT). Nonetheless, CEUS in pediatrics remains limited by the lack of strong evidence. The purpose of this study was to offer a systematic review on the use of CEUS in pediatric abdominal trauma. METHODS: Electronic search of PubMed, EMBASE and Cochrane databases of studies investigating CEUS for abdominal trauma in children. The risk of bias was assessed using the ROBINS-I tool. RESULTS: This systematic review included 7 studies. CEUS was performed with different ultrasound equipment, always with a curvilinear transducer. Six out of seven studies used a second-generation contrast agent. No immediate adverse reactions were reported. The dose of contrast agent and the scanning technique varied between studies. All CEUS exams were performed by radiologists, in the radiology department or at the bedside. No standard training was reported to become competent in CEUS. The range of sensitivity and specificity of CEUS were 85.7 to 100% and 89 to 100%, respectively. CONCLUSION: CEUS appears to be safe and accurate to identify abdominal solid organ injuries in children with BAT. Further research is necessary to assess the feasibility of CEUS by non-radiologists, the necessary training, and the benefit-cost ratio of CEUS as a tool to potentially reduce CT scans.
Authors: Vicki E Noble; Michael Blaivas; Robert Blankenship; Gerardo Chiricolo; Anthony Dean; J Christian Fox; Romolo Gaspari; Beatrice Hoffmann; Beatrice Hoffman; Robert Jones; Christopher Moore; Paul Sierzenski; Vivek Tayal; Robert Tillotson Journal: Ann Emerg Med Date: 2010-05 Impact factor: 5.721
Authors: J Montoya; S P Stawicki; D C Evans; D P Bahner; S Sparks; R P Sharpe; J Cipolla Journal: Eur J Trauma Emerg Surg Date: 2015-03-14 Impact factor: 3.693
Authors: Christian J Streck; Adam M Vogel; Jingwen Zhang; Eunice Y Huang; Matthew T Santore; Kuojen Tsao; Richard A Falcone; Melvin S Dassinger; Robert T Russell; Martin L Blakely Journal: J Am Coll Surg Date: 2017-01-24 Impact factor: 6.113
Authors: Lindsey B Armstrong; David P Mooney; Harriet Paltiel; Carol Barnewolt; Beatrice Dionigi; Mary Arbuthnot; Chinwendu Onwubiko; Susan A Connolly; Delma Y Jarrett; Jill M Zalieckas Journal: J Pediatr Surg Date: 2017-03-20 Impact factor: 2.545
Authors: James F Holmes; Kathleen Lillis; David Monroe; Dominic Borgialli; Benjamin T Kerrey; Prashant Mahajan; Kathleen Adelgais; Angela M Ellison; Kenneth Yen; Shireen Atabaki; Jay Menaker; Bema Bonsu; Kimberly S Quayle; Madelyn Garcia; Alexander Rogers; Stephen Blumberg; Lois Lee; Michael Tunik; Joshua Kooistra; Maria Kwok; Lawrence J Cook; J Michael Dean; Peter E Sokolove; David H Wisner; Peter Ehrlich; Arthur Cooper; Peter S Dayan; Sandra Wootton-Gorges; Nathan Kuppermann Journal: Ann Emerg Med Date: 2013-02-01 Impact factor: 5.721
Authors: David H Wisner; Nathan Kuppermann; Arthur Cooper; Jay Menaker; Peter Ehrlich; Josh Kooistra; Prashant Mahajan; Lois Lee; Lawrence J Cook; Kenneth Yen; Kathy Lillis; James F Holmes Journal: J Trauma Acute Care Surg Date: 2015-08 Impact factor: 3.313
Authors: Gibran T Yusuf; Maria E Sellars; Annamaria Deganello; David O Cosgrove; Paul S Sidhu Journal: AJR Am J Roentgenol Date: 2016-12-13 Impact factor: 3.959