Ong Adrian W, McKenney Mark G, McKenney Kimberley A, Brown Margaret, Namias Nicholas, MaCloud Jana, Cohn Stephen M
Department of Surgery, University of Miami Medical School, FL, USA.
J Trauma. 2003 Mar;54(3):503-8. doi: 10.1097/01.TA.0000051587.50251.3D.
It is possible to quantify the amount of hemoperitoneum seen on focused assessment with sonography for trauma (FAST) using a simple scoring system that had previously been shown to correlate with the need for subsequent laparotomy in adults. A score of 3 or greater was shown to be highly accurate in predicting the need for laparotomy. We hypothesized that this scoring system might also predict the need for laparotomy in pediatric trauma patients.
We retrospectively reviewed all records for patients 15 years and younger who underwent FAST after blunt trauma. A "positive" ultrasound examination was defined as one containing free intraperitoneal fluid with or without solid organ injury. The ultrasound score (USS) was defined as the depth of the deepest pocket of fluid collection measured in centimeters plus the number of additional spaces where fluid was seen.
Thirty-eight (19.6%) of 193 patients who had FAST performed had positive ultrasound examinations. Thirty-seven patients with complete records were analyzed. There were no differences between patients with a USS < or = 3.0 and those with a USS > 3.0 in terms of admission pulse, Glasgow Coma Scale score, Injury Severity Score, or the proportion of patients who were initially hypotensive. One of 22 patients with a USS < or = 3.0 required therapeutic laparotomy versus 8 of 15 patients with a USS > 3.0 ( = 0.002). For a USS > 3.0, sensitivity, specificity, and accuracy in predicting therapeutic laparotomy were 89%, 75%, and 78%, respectively.
Ultrasound quantification of hemoperitoneum by a simple scoring system may serve as a useful adjunct to traditional clinical parameters in predicting the need for subsequent laparotomy in pediatric patients. Prospective validation with a larger study is required.
使用一种简单的评分系统可以对创伤重点超声评估（FAST）中所见的腹腔积血进行量化，该评分系统先前已被证明与成人后续剖腹手术的需求相关。3分或更高的分数在预测剖腹手术需求方面显示出高度准确性。我们假设该评分系统也可能预测小儿创伤患者的剖腹手术需求。
我们回顾性分析了15岁及以下钝性创伤后接受FAST检查的所有患者的记录。“阳性”超声检查定义为包含腹腔内游离液体且有或无实质性器官损伤的检查。超声评分（USS）定义为以厘米为单位测量的最深液体积聚腔的深度加上发现液体的其他腔隙数量。
193例接受FAST检查的患者中有38例（19.6%）超声检查呈阳性。对37例记录完整的患者进行了分析。USS≤3.0的患者与USS>3.0的患者在入院脉搏、格拉斯哥昏迷量表评分、损伤严重程度评分或初始低血压患者比例方面没有差异。USS≤3.0的22例患者中有1例需要进行治疗性剖腹手术，而USS>3.0的15例患者中有8例（P = 0.002）。对于USS > 3.0，预测治疗性剖腹手术的敏感性、特异性和准确性分别为89%、75%和78%。
通过简单评分系统对腹腔积血进行超声量化，可能作为预测小儿患者后续剖腹手术需求的传统临床参数的有用辅助手段。需要进行更大规模研究的前瞻性验证。
