Holmes James F, Gladman Aaron, Chang Cindy H
Department of Emergency Medicine, UC Davis School of Medicine, Davis, Sacramento, CA 95817, USA.
J Pediatr Surg. 2007 Sep;42(9):1588-94. doi: 10.1016/j.jpedsurg.2007.04.023.
The objective of the study was to obtain the best estimates of the test performance of abdominal ultrasonography (US) for identifying children with intraabdominal injuries (IAIs).
We gathered studies on the use of abdominal US in injured children from the following sources: a MEDLINE and Embase search, hand searches of 5 specialty journals and 4 clinical textbooks, the bibliographies of all identified articles, and contact with experts. Both prospective and retrospective studies were included if they used abdominal US for the detection of intraperitoneal fluid or IAIs in blunt trauma patients less than 18 years of age. All authors independently abstracted data from the selected studies. Disagreements between abstractors were resolved by mutual agreement.
Twenty-five articles met the inclusion criteria, and 3838 children evaluated with abdominal US were included. Abdominal US had the following test characteristics for identifying children with hemoperitoneum: sensitivity, 80% (95% confidence interval [CI] 76%-84%); specificity, 96% (95% CI 95%-97%); positive likelihood ratio, 22.9 (95% CI 17.2-30.5); and negative likelihood ratio, 0.2 (95% CI 0.16-0.25). Using the most methodologically rigorous studies, however, yielded the following test characteristics of abdominal US for identifying children with hemoperitoneum: sensitivity, 66% (95% CI 56%-75%); specificity, 95% (95% CI 93%-97%); positive likelihood ratio, 14.5 (95% CI 9.5-22.1); and negative likelihood ratio, 0.36 (95% CI 0.27-0.47).
Abdominal US has a modest sensitivity for the detection of children with hemoperitoneum; however, its test performance characteristics worsen when only the most methodologically rigorous articles are included. A negative US examination has questionable utility as the sole diagnostic test to rule out the presence of IAI. Because of the high risk of IAI, a hemodynamically stable child with a positive US examination should immediately undergo abdominal computed tomographic scanning.
本研究的目的是获得腹部超声（US）用于识别腹腔内损伤（IAI）患儿的最佳检测性能估计值。
我们从以下来源收集了关于腹部超声在受伤儿童中应用的研究：MEDLINE和Embase检索、对5种专业期刊和4本临床教科书的手工检索、所有已识别文章的参考文献以及与专家的联系。如果前瞻性和回顾性研究使用腹部超声检测18岁以下钝性创伤患者的腹腔内积液或IAI，则纳入研究。所有作者独立从选定的研究中提取数据。提取者之间的分歧通过相互协商解决。
25篇文章符合纳入标准，纳入了3838例接受腹部超声检查的儿童。腹部超声用于识别腹腔积血患儿的检测特征如下：敏感性为80%（95%置信区间[CI]76%-84%）；特异性为96%（95%CI 95%-97%）；阳性似然比为22.9（95%CI 17.2-30.5）；阴性似然比为0.2（95%CI 0.16-0.25）。然而，使用方法学上最严谨的研究得出腹部超声用于识别腹腔积血患儿的检测特征如下：敏感性为66%（95%CI 56%-75%）；特异性为95%（95%CI 93%-97%）；阳性似然比为14.5（95%CI 9.5-22.1）；阴性似然比为0.36（95%CI 0.27-0.47）。
腹部超声检测腹腔积血患儿的敏感性一般；然而，当仅纳入方法学上最严谨的文章时，其检测性能特征会变差。超声检查结果为阴性作为排除IAI存在的唯一诊断试验，其效用存疑。由于IAI风险高，超声检查结果为阳性的血流动力学稳定患儿应立即接受腹部计算机断层扫描。
