Hostname: page-component-848d4c4894-tn8tq Total loading time: 0 Render date: 2024-06-20T16:44:02.049Z Has data issue: false hasContentIssue false
  • English
  • Français

Bedside emergency department ultrasonography availability and use for blunt abdominal trauma in Canadian pediatric centres

Published online by Cambridge University Press:  11 May 2015

Robin Cardamore ,
Joe Nemeth  and
Christine Meyers
Robin Cardamore*
Affiliation:
Emergency Medicine Residency Training Program, McGill University, Montreal, QC
Joe Nemeth
Affiliation:
Emergency Medicine Residency Training Program, McGill University, Montreal, QC
Christine Meyers
Affiliation:
Emergency Medicine Residency Training Program, McGill University, Montreal, QC
*
McGill University Emergency Medicine Residency Training Program, Room A4.62, Royal Victoria Hospital, 687 Pine Avenue West, Montreal, QC H3A 1A1; robin.cardamore@mail.mcgill.ca

Abstract

Core share and HTML view are not available for this content. However, as you have access to this content, a full PDF is available via the ‘Save PDF’ action button.
Objectives:

To quantify the current availability and use of bedside emergency department ultrasonography (EDUS) for blunt trauma at Canadian pediatric centres and to identify any perceived barriers to the use of bedside EDUS in such centres.

Methods:

An electronic survey was sent to 162 pediatric emergency physicians and 12 site directors from the 12 pediatric emergency departments across Canada.

Results:

Ninety-two percent (11 of 12) of centres completed the survey. The individual physician response rate was 65% (106 of 162), with 100% of site directors responding. Ultrasound machines were available in 45% (5 of 11) of centres. Forty-two percent (32 of 77) of emergency physicians working in equipped pediatric centres used bedside EDUS to evaluate blunt abdominal trauma (BAT). In the subgroup of staff who also worked at adults sites, the frequency of ultrasonography use for the evaluation of pediatric BAT was 75%. In the 55% (6 of 11) of centres without ultrasonography, 88% of staff intend to incorporate its use in the future and 81% indicated that they believed the incorporation of ultrasonography would have a positive impact on patient care. The main perceived barriers to the use of ultrasonography in the evaluation of BAT were a lack of training (41%) and a lack of equipment (26%).

Conclusion:

Bedside EDUS is currently used in almost half of pediatric trauma centres, a frequency that is significantly lower than adult centres. Physicians in pediatric centres who use ultrasonography report that it has a high utility, and a great majority of physicians at pediatric centres without EDUS plan to incorporate it in the future. The main reported barriers to its use are a lack of training and a lack of equipment availability.

Keywords

abdominalpediatricprevalencetraumaultrasonography
Type
Original Research • Recherche originale
Information
Canadian Journal of Emergency Medicine , Volume 14 , Issue 1 , January 2012 , pp. 14 - 19
Copyright
Copyright © Canadian Association of Emergency Physicians 2012

References

REFERENCES

1.Centers for Disease Control and Prevention. Deaths, leading causes for 2004. Natl Vital Stat Rep 2004.Google Scholar
2.Fenton, SJ, Hansen, KW, Meyes, RL, et al. CT scan and the pediatric trauma patient—are we overdoing it? J Pediatr Surg 2004;39:1877–81, doi:10.1016/j.jpedsurg.2004.08.007.CrossRefGoogle Scholar
3.Taylor, GA, Eichelberger, MR. Abdominal CT in children with neurologic impairment following blunt trauma. Ann Surg 1989;210:229–33, doi:10.1097/00000658-198908000-00016.Google Scholar
4.Brenner, D, Elliston, C, Hall, E, et al. Estimated risks of radiation-induced fatal cancer from pediatric CT. AJR Am J Roentgenol 2001;176:289–96.Google Scholar
5.Slovis, TL. Children, computed tomography radiation dose, and the As Low As Reasonably Achievable (ALARA) concept. Pediatrics 2003;112:971–2, doi:10.1542/peds.112.4.971.Google Scholar
6.Brenner, DJ. Estimating cancer risks from pediatric CT: going from the qualitative to the quantitative. Pediatr Radiol 2002;32:228–31, doi:10.1007/s00247-002-0671-1.CrossRefGoogle ScholarPubMed
7.Jindal, A, Velmahos, GC, Rofougaran, R. Computed tomography for evaluation of mild to moderate pediatric trauma: are we overusing it? World J Surg 2002;26:13–6, doi:10.1007/s00268-001-0174-5.CrossRefGoogle Scholar
8.Boulanger, BR, McLellan, BA, Brenneman, FD, et al. Emergent abdominal sonography as a screening test in a new diagnostic algorithm for blunt trauma. J Trauma 1996;40:867–74, doi:10.1097/00005373-199606000-00003.CrossRefGoogle Scholar
9.McKenney, MG, Martin, L, Lentz, K, et al. 1,000 consecutive ultrasounds for blunt abdominal trauma. J Trauma 1996;40: 607–10, doi:10.1097/00005373-199604000-00015.Google Scholar
10.Rozycki, GS, Ochsner, MG, Jaffin, JH, et al. Prospective evaluation of surgeons’ use of ultrasound in the evaluation of trauma patients. J Trauma 1993;34:516–26, doi:10.1097/00005373-199304000-00008.Google Scholar
11.Melniker, LA, Leibner, E, McKenney, MG, et al. Randomized controlled clinical trial of point-of-care, limited ultrasonography for trauma in the emergency department: the first sonography outcomes assessment program trial. Ann Emerg Med 2006;48:227–35, doi:10.1016/j.annemergmed.2006.01.008.CrossRefGoogle ScholarPubMed
12.Holmes, JF, Gladman, A, Chang, CH. Performance of abdominal ultrasonography in pediatric blunt trauma patients: a meta-analysis. J Pediatr Surg 2007;42:1588–94, doi:10.1016/j.jpedsurg.2007.04.023.Google Scholar
13.Stengel, D, Bauwens, K, Sehouli, J, et al. Systematic review and meta-analysis of emergency ultrasonography for blunt abdominal trauma. Br J Surg 2001;88:901–12, doi:10.1046/j.0007-1323.2001.01777.x.Google Scholar
14.Suthers, SE, Albrecht, R, Foley, D, et al. Surgeon-directed ultrasound for trauma is a predictor of intra-abdominal injury in children. Am Surg 2004;70:164–7.Google Scholar
15.Hockberger, RS, Binder, LS, Graber, MA, et al. The model of the clinical practice of emergency medicine. Ann Emerg Med 2001;37:745–70, doi:10.1067/mem.2001.115495.Google Scholar
16.Heller, MB, Mandavia, D, Tayal, VS, et al. Residency training in emergency ultrasound: fulfilling the mandate. Acad Emerg Med 2002;9:835–9, doi:10.1111/j.1553-2712.2002.tb02174.x.Google Scholar
17.Royal College of Physicians and Surgeons of Canada. Objectives of training in emergency medicine. Policies and procedures booklet. 2008.Google Scholar
18.Baka, AG, Delgado, CA, Simon, HK. Current use and perceived utility of ultrasound for evaluation of pediatric compared with adult trauma patients. Pediatr Emerg Care 2002;18:163–7, doi:10.1097/00006565-200206000-00003.Google Scholar
19.Chen, L, Santucci, A. Probing the availability of emergency ultrasound in pediatrics [abstract]. Pediatr Emerg Care 2006; 22:688, doi:10.1097/00006565-200609000-00041.Google Scholar
20.Scaife, E, Fenton, SJ, Hansen, KW, et al. Use of focused abdominal sonograpy for trauma at pediatric and adult trauma centers: a survey. J Pediatr Surg 2009;44:1746–9, doi:10.1016/j.jpedsurg.2009.01.018.Google Scholar
21.Dillman, DA. Mail and telephone surveys: the Total Design Method. New York: Wiley; 1978.Google Scholar
22.Brooks, AJ, Price, V, Simms, M. FAST on operational military deployment. Emerg Med J 2005;22:263–5, doi:10.1136/emj.2004.014308.Google Scholar
23.Sarkisian, AE, Khondkarian, RA, Amirbekian, NM, et al. Sonographic screening of mass casualties for abdominal and renal injuries following the 1988 Armenian earthquake. J Trauma 1991;31:247–50.Google Scholar
24.Fernandez, L, McKenney, MG, McKenney, KL, et al. Ultrasound in blunt abdominal trauma. J Trauma 1998;45:841–8, doi:10.1097/00005373-199810000-00047.CrossRefGoogle ScholarPubMed
25.Dolich, MO, McKenney, MG, Varela, JE, et al. 2,576 ultrasounds for blunt abdominal trauma. J Trauma 2001;50:108–12, doi:10.1097/00005373-200101000-00019.Google Scholar
26.Taylor, GA, Sivit, CJ. Posttraumatic peritoneal fluid: is it a reliable indicator of intraabdominal injury in children. J Pediatr Surg 1995;30:1644–8, doi:10.1016/0022-3468(95)90442-5.CrossRefGoogle ScholarPubMed
27.Akgür, FM, Tanyel, FC, Akhan, O, et al. The place of ultrasonographic examination in the initial evaluation of children sustaining blunt abdominal trauma. J Pediatr Surg 1993;28:78–81, doi:10.1016/S0022-3468(05)80361-6.Google Scholar
28.Coley, BD, Mutabagani, KH, Martin, LC, et al. Focused abdominal sonography for trauma (FAST) in children with blunt abdominal trauma. J Trauma 2000;48:902–6, doi:10.1097/00005373-200005000-00014.Google Scholar
29.Soundappan, SV, Holland, AJ, Cass, DT, et al. Diagnostic accuracy of surgeon-performed focused abdominal sonography (FAST) in blunt paediatric trauma. Injury 2005;36:970–5, doi:10.1016/j.injury.2005.02.026.Google Scholar
30.Taylor, GA, Fallat, ME, Potter, BM, et al. The role of computed tomography in blunt abdominal trauma inchildren. J Trauma 1988;28:1660–4, doi:10.1097/00005373-198812000-00008.Google Scholar