Performance of abdominal ultrasonography in pediatric
blunt trauma patients: a meta-analysis
James F. Holmes
, Aaron Gladman
, Cindy H. Chang
Department of Emergency Medicine, UC Davis School of Medicine, Davis, Sacramento, CA 95817, USA
UC Davis School of Medicine, Davis, CA 95616, USA
Mercy San Juan Medical Center, Carmichael, CA 95608, USA
Objective: The objective of the study was to obtain the best estimates of the test performance of
abdominal ultrasonography (US) for identifying children with intraabdominal injuries (IAIs).
Methods: We gathered studies on the use of abdominal
in injured children from the following sources:
a MEDLINE and Embase search, hand searches of 5 specialty journals and 4 clinical textbooks, the
bibliographies of all identified articles, and contact with experts. Both prospective and retrospective
studies were included if they used abdominal US for the detection of intraperitoneal fluid or IAIs in blunt
trauma patients less than 18 years of age. All authors independently abstracted data from the selected
studies. Disagreements between abstractors were resolved by mutual agreement.
Results: Twenty-five articles met the inclusion criteria, and 3838 children evaluated with abdominal US
were included. Abdominal US had the following test characteristics for identifying children with
hemoperitoneum: sensitivity, 80% (95% confidence interval [CI] 76%-84%); specificity, 96% (95% CI
95%-97%); positive likelihood ratio, 22.9 (95% CI 17.2-30.5); and negative likelihood ratio, 0.2 (95% CI
0.16-0.25). Using the most methodologically rigorous studies, however, yielded the following test
characteristics of abdominal US for identifying children with hemoperitoneum: sensitivity, 66% (95% CI
56%-75%); specificity, 95% (95% CI 93%-97%); positive likelihood ratio, 14.5 (95% CI 9.5-22.1); and
negative likelihood ratio, 0.36 (95% CI 0.27-0.47).
Conclusions: Abdominal US has a modest sensitivity for the detection of children with hemoperitoneum;
however, its test performance characteristics worsen when only the most methodologically rigorous
articles are included. A negative US examination has questionable utility as the sole diagnostic test to rule
out the presence of IAI. Because of the high risk of IAI, a hemodynamically stable child with a positive
US examination should immediately undergo abdominal computed tomographic scanning.
© 2007 Elsevier Inc. All rights reserved.
Blunt traumatic injury is the most common cause of death and
disability in childhood . Historical and physical examination
findings in injured children are limited; thus, identification of
intraabdominal injuries (IAIs) may be difficult [2,3]. Although
abdominal computed tomographic (CT) scanning is the reference
standard for identifying IAIs, recent concerns regarding the risk of
radiation-induced malignancy have questioned the widespread use
of abdominal CT, especially in the pediatric population [4-6].
Abdominal ultrasonography has recently garnered favor in the
diagnostic evaluation of adult patients with blunt abdominal
trauma, and the Focused Assessment with Sonography for Trauma
Corresponding author. Tel.: +1 916 734 1539; fax: +1 916 734 7950.
E-mail address: email@example.com (J.F. Holmes).
0022-3468/$ – see front matter © 2007 Elsevier Inc. All rights reserved.
Journal of Pediatric Surgery (2007) 42, 1588–1594