Md Majid Anwer
Jai Prakash Narayan Apex Trauma Center, India
Title: To determine the accuracy of focused assessment with sonography for trauma and its comparative analysis with CECT torso in pediatrics in emergency trauma department of a level 1 trauma center of India
Biography
Biography: Md Majid Anwer
Abstract
Introduction: Focused assessment with sonography for trauma is an important skill during trauma resuscitation. It has been the initial diagnostic modality of choice during trauma. Its use however may result in underdiagnoses of potentially life threatening injuries, which are otherwise picked up on contrast enhanced CT scan. Its diagnostic accuracy in pediatric trauma remained to be determined.
Aim: The aim of this study was to determine the accuracy of focused assessment with sonography for trauma and its comparative analysis with CECT torso in pediatrics in emergency trauma department of a level 1 trauma center of India.
Materials & Methods: A prospective study was done on pediatric age group in trauma emergency during primary survey of resuscitation in resuscitation bay or red area in the age group of 1-18 years of age. All cases are taken into study that has entered in our center (AIIMS Delhi) in period from April 2018 to July 2018. The fast examination was done by radiology residents. All those patients who had positive findings went for CECT. The data analysis was done using the latest version of SPSS.
Results: During the period from April 2018 to August 2018, a total of 200 pediatric patients were triaged in red areas using START triage protocol. Of the 200 pediatric patients examined, majority victims were males (63%), followed by females (37%). The present study revealed that the majority affected age group is 1-5 years in pediatric trauma. Fall from height (FFH) were the most common mode of trauma seen in 68.5% of our patients, followed by road traffic injuries. Chest compression defined as a crepitation or tenderness elicited on deep palpation of chest was found in 4.5% of patients. The pelvic compression test used to diagnose pelvic fracture and sacroiliac joint lesion were positive in four cases (2%). The sensitivity of FAST to detect abnormal findings relative to CT was 24 (true positive), 40% and specificity of FAST relative to CT was 128 (true negative), 91.40%. Twelve patients were false positive. Thirty six patients were false negative.
Discussion: The positive predictive value and the negative predictive value of the test is 66.70% and 78% respectively. Balanatrajan et al. showed sensitivity, specificity, positive and negative predictive values as 43%, 99%, 95% and 94% respectively. The sensitivity of FAST in the literature varies between 63% and 96% (23). Lee et al. evaluated the use of ultrasonography for the triage of blunt abdominal trauma patients for exploratory laparotomy. Their results for the normotensive patients showed sensitivity, specificity, negative and positive predictive values as 85%, 96%, 99%, and 96% respectively, for the FAST study. Our sensitivity, specificity and negative, positive predictive values could be low because of more children in one to five years of age.
Conclusion: The ultrasound missed some important findings which were later detected on CT scan. Given the low sensitivity, a negative focused assessment with sonography for trauma without confirmation by computerized tomography may result in missed intra-abdominal injuries in pediatric patients.