Document Type: Original Article


Emergency Medicine Research Center, Department of Emergency Medicine, Isfahan University of Medical Sciences, Isfahan, Iran


Objective: The present study examines the diagnostic accuracy of abdominal ultrasonography and urinalysis test in children with blunt abdominal trauma, compared with CT scan. The aim of this study was to compare the diagnostic value of ultrasound and urinalysis test with CT scan as a golden standard diagnostic method in predicting abdominal peritoneal injury in these patients.
Methods: This prospective study, based on diagnostic accuracy evaluation, was performed on children with blunt abdominal traumas less than 12 years of age who were referred to the emergency department from 2017-2018 and for whom abdominal ultrasonography, urinalysis and abdominal CT scans were requested. Demographic data, mechanism of trauma, the results of urine tests, ultrasound and CT scan of the abdomen were recorded. Sensitivity, specificity, positive and negative predictive values were used to measure the diagnostic power of the tests.
Results: In this study, 100 children with multiple traumas were included. The mean age of these patients was 5.75 ± 3 years with a range of 1-12 years. In terms of sexual distribution, 69 (69%) were boys and 31 (31%) were girls. According to the results, ultrasound with an abnormal urinalysis test had sensitivity of 85.7%, specificity of 91.9%, positive predictive value of 63.2% and negative predictive value of 97.5%. The accuracy was 91%.
Conclusion: According to the results of this study, the combination of ultrasonography and urinalysis resulted in a significant increase in diagnostic value (P <0.001). Pediatric patients with a negative ultrasonography and urinalysis test should be observed rather than subjected to the radiation risk of CT.


Main Subjects

1. Schmidt TA, Salo D, Hughes JA, Abbott JT, GeidermanJM, Johnson CX, et al. Confronting the ethical challenges to informed consent in emergency medicine research. Acad Emerg Med 2004; 11(10): 1082-9. doi: 10.1197/j.aem.2004.05.028.
2. Arias E, MacDorman MF, Strobino DM, Guyer B. Annual summary of vital statistics--2002. Pediatrics 2003; 112(6 Pt1): 1215-30.
3. Soudack M, Epelman M, Maor R, Hayari L, Shoshani G, Heyman‐Reiss A, et al. Experience with focused abdominal
sonography for trauma (FAST) in 313 pediatric patients. J Clin Ultrasound 2004 ;32(2):53-61. doi: 10.1002/jcu.10232.
4. Poletti PA, Kinkel K, Vermeulen B, Irmay F, Unger PF, Terrier F. Blunt abdominal trauma: should US be used to detect both free fluid and organ injuries? Radiology 2003; 227(1): 95-103. doi: 10.1148/radiol.2271020139.
5. Kirkpatrick AW. Clinician-performed focused sonography for the resuscitation of trauma. Crit Care Med 2007; 35(5 Suppl): S162-72. doi: 10.1097/01.ccm.0000260627.97284.5d.
6. Ashrafi A, Heydari F, Kolahdouzan M. The utility of ultrasound and laboratory data for predicting intraabdominal injury among children with blunt abdominal trauma. Int J Pediatr 2018; 6(8): 8047-59. doi: 10.22038/ijp.2018.29824.2626.
7. Meera T, Nabachandra H. A study of pattern and injury severity score in blunt thoraco-abdominal trauma cases in
Manipal. Medico-Legal Update 2005; 5(2): 47-52.
8. Goletti O, Ghiselli G, Lippolis PV, Chiarugi M, Braccini G, Macaluso C, et al. The role of ultrasonography in blunt abdominal trauma: results in 250 consecutive cases. J Trauma 1994; 36(2): 178-81.
9. Patel JC, Tepas J 3rd. The efficacy of focused abdominal sonography for trauma (FAST) as a screening tool in the assessment of injured children. J Pediatr Surg 1999; 34(1): 44-7.
10. Akgur FM, Aktug T, Kovanhkaya A, Erdag G, Olguner M, Hosgor M, et al. Initial evaluation of children sustaining
blunt abdominal trauma: ultrasonography vs. diagnostic peritoneal lavage. Eur J Pediatr Surg 1993; 3(5): 278-80. doi:
11. Luks FI, Lemire A, St-Vil D, Di Lorenzo M, Filiatrault D, Ouimet A. Blunt abdominal trauma in children: the practical value of ultrasonography. J Trauma 1993; 34(5): 607-10.
12. Filiatrault D, Longpre D, Patriquin H, Perreault G, Grignon A, Pronovost J, et al. Investigation of childhood blunt abdominal trauma: a practical approach using ultrasound as the initial diagnostic modality. Pediatr Radiol 1987; 17(5): 373-9.

13. Hoelzer DJ, Brian MB, Balsara VJ, Varner WD, Flynn TC, Miner ME. Selection and nonoperative management of pediatric blunt trauma patients: the role of quantitative crystalloid resuscitation and abdominal ultrasonography. J Trauma 1986; 26(1): 57-62.

14. Fox JC, Boysen M, Gharahbaghian L, Cusick S, Ahmed SS, Anderson CL, et al. Test characteristics of focused assessment of sonography for trauma for clinically significant abdominal free fluid in pediatric blunt abdominal trauma. Acad Emerg Med 2011; 18(5): 477-82. doi: 10.1111/j.1553-2712.2011.01071.x.
15. Raz O, Haifler M, Copel L, Lang E, Abu-Kishk I, Eshel G, et al. Use of adult criteria for slice imaging may limit unnecessary radiation exposure in children presenting with hematuria and blunt abdominal trauma. Urology 2011;
77(1): 187-90. doi: 10.1016/j.urology.2010.05.014.
16. Kim CH, Shin SD, Song KJ, Park CB. Diagnostic accuracy of focused assessment with sonography for trauma (FAST) examinations performed by emergency medical technicians. Prehosp Emerg Care 2012; 16(3): 400-6. doi: 10.3109/10903127.2012.664242.
17. Retzlaff T, Hirsch W, Till H, Rolle U. Is sonography reliable for the diagnosis of pediatric blunt abdominal trauma? J Pediatr Surg 2010; 45(5): 912-5. doi: 10.1016/j. jpedsurg.2010.02.020.
18. Kessler DO. Abdominal Ultrasound for Pediatric Blunt Trauma: FAST Is Not Always Better. JAMA 2017; 317(22): 2283-5. doi: 10.1001/jama.2017.6163.
19. Sola JE, Cheung MC, Yang R, Koslow S, Lanuti E, Seaver C, et al. Pediatric FAST and elevated liver transaminases: An
effective screening tool in blunt abdominal trauma. J Surg Res 2009; 157(1): 103-7. doi: 10.1016/j.jss.2009.03.058.
20. Scaife ER, Rollins MD, Barnhart DC, Downey EC, Black RE, Meyers RL, et al. The role of focused abdominal sonography for trauma (FAST) in pediatric trauma evaluation. J Pediatr Surg 2013; 48(6): 1377-83. doi:10.1016/j.jpedsurg.2013.03.038.