Use of Abdominal Ultrasonography to Assess Pediatric Splenic Trauma. Potential Pitfalls in the Diagnosis

Overview

Journal Ann Surg

Specialty General Surgery

Date 1997 Apr 1

PMID 9114800

Citations 7

Authors

A S Krupnick

D H Teitelbaum

J D Geiger

P J Strouse

C S Cox

C E Blane

T Z POLLEY

Affiliations

Soon will be listed here.

Abstract

Objective: The purpose of this study was to evaluate the accuracy of abdominal ultrasonography (US) for screening and grading pediatric splenic injury.

Summary Background Data: The use of abdominal US has increased rapidly as a method of evaluating organ damage after blunt abdominal trauma. Despite US's increasing use, little is known about its accuracy in children with splenic injury.

Methods: Children (N = 32) suffering blunt abdominal trauma who were diagnosed with splenic injury by computerized tomography (CT) scan prospectively were enlisted in this study. Degree of splenic injury was evaluated by both CT and US. The ultrasounds were evaluated by an initial reading as well as by a radiologist who was blinded as to the results of the CT.

Results: Twelve (38%) of the 32 splenic injuries found on CT were missed completely on the initial reading of the US. When the ultrasounds were graded in a blinded fashion, 10 (31%) of the splenic lacerations were missed and 17 (53%) were downgraded. Seven (22%) of the 32 splenic fractures were not associated with any free intraperitoneal fluid on the CT scan.

Conclusions: This study has shown that US has a low level of sensitivity (62% to 78%) in detecting splenic injury and downgrades the degree of injury in the majority of cases. Reliance on free intraperitoneal fluid may be inaccurate because not all patients with splenic injury have free intra-abdominal fluid. Based on these findings, US may be of limited use in the initial assessment, management, and follow-up of pediatric splenic trauma.

Citing Articles

The Diagnosis and Management of Pediatric Blunt Abdominal Trauma-A Comprehensive Review.

Baskovic M, Keretic D, Lackovic M, Boric Krakar M, Pogorelic Z Diagnostics (Basel). 2024; 14(20).

PMID: 39451580 PMC: 11506325. DOI: 10.3390/diagnostics14202257.

Point-of-care ultrasonography for diagnosing thoracoabdominal injuries in patients with blunt trauma.

Stengel D, Leisterer J, Ferrada P, Ekkernkamp A, Mutze S, Hoenning A Cochrane Database Syst Rev. 2018; 12:CD012669.

PMID: 30548249 PMC: 6517180. DOI: 10.1002/14651858.CD012669.pub2.

Pediatric blunt splenic trauma: a comprehensive review.

Lynn K, Werder G, Callaghan R, Sullivan A, Jafri Z, Bloom D Pediatr Radiol. 2009; 39(9):904-16.

PMID: 19639310 DOI: 10.1007/s00247-009-1336-0.

Imaging of paediatric splenic injury with contrast-enhanced ultrasonography.

Oldenburg A, Hohmann J, Skrok J, Albrecht T Pediatr Radiol. 2003; 34(4):351-4.

PMID: 14652701 DOI: 10.1007/s00247-003-1092-5.

Splenectomy after paediatric trauma: could more spleens be saved?.

Godbole P, Stringer M Ann R Coll Surg Engl. 2002; 84(2):106-8.

PMID: 11995746 PMC: 2503773.

References

SIZER J, Wayne E, FREDERICK P . Delayed rupture of the spleen. Review of the literature and report of six cases. Arch Surg. 1966; 92(3):362-6. DOI: 10.1001/archsurg.1966.01320210042007. View

Moss A, Korobkin M, Price D, Brito A . Computed tomography of splenic subcapsular hematomas: an experimental study in dogs. Invest Radiol. 1979; 14(1):60-4. DOI: 10.1097/00004424-197901000-00010. View

Wesson D, FILLER R, Ein S, Shandling B, Simpson J, STEPHENS C . Ruptured spleen--when to operate?. J Pediatr Surg. 1981; 16(3):324-6. DOI: 10.1016/s0022-3468(81)80689-6. View

Jeffrey R, Laing F, Federle M, Goodman P . Computed tomography of splenic trauma. Radiology. 1981; 141(3):729-32. DOI: 10.1148/radiology.141.3.7302229. View

Karp M, Cooney D, Pros G, Newman B, JEWETT Jr T . The nonoperative management of pediatric hepatic trauma. J Pediatr Surg. 1983; 18(4):512-8. DOI: 10.1016/s0022-3468(83)80211-5. View

Kaufman R, Towbin R, Babcock D, Gelfand M, Guice K, Oldham K . Upper abdominal trauma in children: imaging evaluation. AJR Am J Roentgenol. 1984; 142(3):449-60. DOI: 10.2214/ajr.142.3.449. View

Lupien C, Sauerbrei E . Healing in the traumatized spleen: sonographic investigation. Radiology. 1984; 151(1):181-5. DOI: 10.1148/radiology.151.1.6701312. View

Zucker K, Browns K, Rossman D, Hemingway D, Saik R . Nonoperative management of splenic trauma. Conservative or radical treatment?. Arch Surg. 1984; 119(4):400-4. DOI: 10.1001/archsurg.1984.01390160036008. View

Solheim K, HOIVIK B . Changing trends in the diagnosis and management of rupture of the spleen. Injury. 1985; 16(4):221-6. DOI: 10.1016/s0020-1383(85)80002-4. View

10.

Adler D, Blane C, Coran A, Silver T . Splenic trauma in the pediatric patient: the integrated roles of ultrasound and computed tomography. Pediatrics. 1986; 78(4):576-80. View

11.

Chambers J, Ratcliffe J, Doig C . Ultrasound in abdominal injury in children. Injury. 1986; 17(6):399-403. DOI: 10.1016/0020-1383(86)90080-x. View

12.

Booth A, Bruce D, STEINER G . Ultrasound diagnosis of splenic injuries in children--the importance of free peritoneal fluid. Clin Radiol. 1987; 38(4):395-8. DOI: 10.1016/s0009-9260(87)80235-0. View

13.

Filiatrault D, LONGPRE D, Patriquin H, Perreault G, Grignon A, Pronovost J . Investigation of childhood blunt abdominal trauma: a practical approach using ultrasound as the initial diagnostic modality. Pediatr Radiol. 1987; 17(5):373-9. DOI: 10.1007/BF02396611. View

14.

Brick S, Taylor G, Potter B, Eichelberger M . Hepatic and splenic injury in children: role of CT in the decision for laparotomy. Radiology. 1987; 165(3):643-6. DOI: 10.1148/radiology.165.3.3685344. View

15.

Buntain W, GOULD H, Maull K . Predictability of splenic salvage by computed tomography. J Trauma. 1988; 28(1):24-34. DOI: 10.1097/00005373-198801000-00004. View

16.

Wiig J, Solheim K, Nygaard K, Anda O, Runden T, Halvorsen J . Splenic injury--a prospective multicentre diagnostic study. Injury. 1987; 18(2):89-92. DOI: 10.1016/0020-1383(87)90179-3. View

17.

Moore E, Shackford S, Pachter H, McAninch J, Browner B, Champion H . Organ injury scaling: spleen, liver, and kidney. J Trauma. 1989; 29(12):1664-6. View

18.

Tso P, Rodriguez A, Cooper C, Militello P, Mirvis S, Badellino M . Sonography in blunt abdominal trauma: a preliminary progress report. J Trauma. 1992; 33(1):39-43; discussion 43-4. DOI: 10.1097/00005373-199207000-00009. View

19.

Siniluoto T, Paivansalo M, Lanning F, Typpo A, Lohela P, Kotaniemi A . Ultrasonography in traumatic splenic rupture. Clin Radiol. 1992; 46(6):391-6. DOI: 10.1016/s0009-9260(05)80685-3. View

20.

Luks F, Lemire A, St-Vil D, Di Lorenzo M, Filiatrault D, Ouimet A . Blunt abdominal trauma in children: the practical value of ultrasonography. J Trauma. 1993; 34(5):607-10; discussion 610-1. DOI: 10.1097/00005373-199305000-00001. View