UC Davis Receives NIH Grant to Study Ultrasound Use in Pediatric Abdominal Emergency Cases

The National Institutes of Health (NIH) has awarded a grant to UC Davis Health’s Department of Emergency Medicine to support a study on the use of ultrasound in the evaluation of pediatric trauma patients.

Co-principal investigators Nathan Kuppermann, MD, MPH, chair of the Department of Emergency Medicine, and James Holmes, MD, MPH, executive vice chair of the Department of Emergency Medicine, will perform a randomized, controlled trial to compare the rates of abdominal computed tomography (CT) scanning of children for suspected intra-abdominal injuries when they do and do not receive an ultrasound during emergency department evaluation.

According to the Centers for Disease Control and Prevention, trauma is the leading cause of death in children in the United States. Among pediatric traumatic deaths, torso trauma (intra-abdominal injuries) accounts for 30% of cases.

Currently, a CT scan is the standard for diagnosing intra-abdominal injuries. However, the procedure is associated with ionizing radiation-inducing malignancies, or cancer, at an estimated rate of one per 500 abdominal CT scans in children younger than five years of age. In adolescents, the figure is one per 600 scans.

Due to this risk, ultrasound has evolved as a diagnostic test for the evaluation for intra-abdominal injuries, however, it has been used primarily in adults. The standard abdominal ultrasound for trauma is referred to as the Focused Assessment Sonography for Trauma (FAST) examination. Advantages of the FAST exam (compared to CT) include:

• bedside availability during emergency department evaluation
• rapid (3-5 minutes) completion
• ability for repeat examinations
• lack of radiation exposure

“Some studies with adult trauma patients have shown that implementation of an emergency department evaluation strategy which includes a FAST examination improves clinical outcomes, decreases complications and hospital length of stay, abdominal CT use and hospital costs,” explained Kuppermann. “However, due to the lack of definitive evidence from studies, FAST examinations are less commonly used in emergency department evaluations of children with abdominal trauma.”

For this study, Kuppermann and Holmes plan to conduct a multicenter randomized, controlled trial of the FAST examination during the initial emergency department evaluation of children with blunt abdominal trauma. They will measure abdominal CT usage and missed intra-abdominal injury rate, which will be defined by an intra-abdominal injury diagnosed after emergency department evaluation. Secondary outcomes will include emergency department length of stay and hospitalization rate.

“Although the sensitivity of the FAST exam for intra-abdominal injuries is lower than a CT scan, as a screening test, it may decrease the need for abdominal CT in children,” Holmes said. “This will decrease abdominal CT use and will increase patient safety by decreasing the risks of radiation-induced malignancies.”