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The author gives an overview of several of the diagnostic applications of ultrasound in the ED, including the bedside FAST scan. He discusses the advantages of ultrasonography for the evaluation of pediatric trauma patients, particularly citing the immediacy of the results, and the avoidance of ionizing radiation. Sivitz does mention a potential pitfall of pediatric FAST scans, which is that occasionally, pediatric solid organs remain encapsulated after trauma, and subsequent FAST scans may give a false-negative result. However, Sivitz questions if organ injuries missed by FAST scans in pediatric patients are of clinical significance.
Sivitz goes on to summarize procedural uses of bedside ultrasound, including locating vessels for vascular access, bladder assessments in pediatric patients prior to urinary catheterization, evaluation for abscesses in soft tissue infections, and foreign body localization. He also touches on the use of ultrasound for the diagnosis of acute fractures in pediatric patients, and notes that while ultrasound is over 90% specific, it’s only 73% sensitive for fracture diagnosis. It is mentioned that successful fracture diagnosis increases significantly when the sonographer is more experienced.
Sivitz, Adam. Ultrasonography: Expanding Bedside Applications in the Pediatric Emergency Department Setting.
Contemporary Pediatrics. 01 Apr. 2011: 48-57.
Bedside ultrasonography is a core component of the practice of emergency medicine, and its use in the pediatric emergency setting has been growing. As a first-line imaging tool, it is improving and easing pediatric patient care.
Remember those days searching in vain for vascular access in the child with sickle-cell disease who always was a difficult stick? Or the febrile toddler with a red foot that you clinically couldn’t decide was an abscess, cellulitis, or an infection caused by a possible subcutaneous foreign body? Or the adolescent girl with a recent positive pregnancy test who was complaining of abdominal pain and vaginal bleeding?
In a busy emergency department (ED), great importance is placed on improving workflow and patient care. Bedside emergency ultrasonography has become a valuable tool for the emergency physician for just these reasons. It is a safe, rapid, goal-directed examination used to answer a focused and important clinical question, often in a yes-or-no fashion. Although it has been well established in the adult emergency setting over the past 20 years, its use is just gaining momentum in the pediatric emergency setting.
Children are the ideal patients for ultrasonography because their smaller bodies allow better penetration of the ultrasound waves compared with adults. Growing concerns regarding the small but significant long-term risks of inducing a fatal cancer as a consequence of ionizing radiation from computed tomography (CT) also makes ultrasound an attractive first-line imaging modality.
To read the complete article for free, visit the Contemporary Pediatrics website by clicking here.
SonoSim Keywords: Ultrasound, Bedside Ultrasound, Pediatrics, Pediatric Ultrasound, FAST Scan