Utility of Abdominal Ultrasound in the Evaluation of Children With Blunt Trauma

Inclusion Criteria:

• Blunt torso trauma resulting from a significant mechanism of injury

  • Motor vehicle collision: greater than 60 mph, ejection, or rollover
  • Automobile versus pedestrian/bicycle: automobile speed > 25 mph
  • Falls greater than 20 feet in height
  • Crush injury to the torso
  • Physical assault involving the abdomen
  • Decreased level of consciousness (Glasgow Coma Scale score < 15 or below age-appropriate behavior) in association with blunt torso trauma

• Blunt traumatic event with any of the following (regardless of the mechanism):

  • Extremity paralysis
  • Multiple long bone fractures (e.g., tibia and humerus fracture)
• History and physical examination suggestive of intra-abdominal injury following blunt torso trauma of any mechanism (including mechanisms of injury of less severity than mentioned above)

Exclusion Criteria:

• No concern for inter-abdominal injury or no planned evaluation for possible IAI
• Prehospital or ED age adjusted Hypotension
• Prehospital or initial ED GCS score ≤ 8
• Presence of an abdominal "seat belt sign" - continuous area of erythema/contusion completely across the lower abdomen secondary to a lap belt
• Penetrating trauma: stab or gunshot wounds
• Traumatic injury occurring > 24 hours prior to the time of presentation to the ED
• Transfer of the patient to the UCDMC ED from an outside facility with abdominal CT scan, diagnostic peritoneal lavage, or laparotomy previously performed
• Patients with known disease processes resulting in intraperitoneal fluid including liver failure and the presence of ventriculoperitoneal shunts