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HIGH-YIELD FACTS

  • Focused assessment with sonography in trauma (FAST) in the hypotensive child allows for rapid identification of life-threatening intraabdominal hemorrhage. In the stable traumatized child, serial FAST improves the identification of occult intraabdominal injuries and may prove to be a useful screening tool aimed at reducing the number of computed tomography (CT) scans obtained.

  • Pediatric point-of-care ultrasound (P-POCUS) of the lungs is proving to be a highly useful application allowing for the accurate diagnosis of lung pathologies among children with undifferentiated respiratory symptoms (e.g., pneumonia, pneumothorax).

  • P-POCUS allows for the more accurate identification of skin and soft-tissue infections requiring incision and drainage, as well as of subcutaneous foreign bodies.

  • P-POCUS can be used to diagnose fractures, joint effusions, and can guide closed reductions of long bone fractures.

Pediatric point-of-care ultrasound (P-POCUS) is a skill that enables physicians to use ultrasound technology as an extension of the physical examination to more accurately, efficiently, and safely manage children with acute medical, surgical, and trauma-related conditions. In this chapter, common indications for P-POCUS are briefly reviewed, including torso trauma, lung, skin and soft-tissue, musculoskeletal, and vascular applications.

TORSO TRAUMA

The focused assessment with sonography in trauma (FAST) scan has been shown to reduce time to operative care, hospital length of stay, use of computed tomography (CT) and hospital costs, as well as improving morbidity in adult trauma patients.1,2 In the persistently unstable child with torso trauma, FAST similarly allows for the rapid identification and management of intraabdominal hemorrhage.3 On the other hand, most children with intraabdominal injuries do not require surgery, and therefore FAST may serve a different goal. The utility of pediatric FAST in diagnosing intraabdominal hemorrhage versus diagnosing any injury versus clinically important injuries has been studied. The difficulty is in the consistent finding that approximately 15% of patients with torso trauma, for whom trauma code activation criteria were met, and likely some of those in whom it was not, have significant occult injuries. The current gold standard is still CT scanning. When FAST is used in the stable pediatric trauma patient in conjunction with other diagnostic examinations, such as physical examination, liver function test, and/or serial FAST, its performance at identifying clinically important intraabdominal injuries improves significantly.4–8 A clinical decision rule incorporating serial FAST will likely improve the sensitivity and specificity of algorithms such as that proposed by Holmes et al.,9 thereby assuring the appropriate group of injured children have diagnostic imaging while not missing clinically important injuries, with the goal of minimizing unnecessary radiation exposure. One study reported that among patients deemed at moderate risk for intraabdominal injury by treating physicians, its use in trauma may have contributed to 10% to 15% fewer CT scans compared to when not used.10

The FAST technique uses a low-frequency curvilinear probe to look at the hepatorenal space (Morison’s pouch) in the right upper quadrant, ...

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