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Peritoneal fluid localization on FAST examination in the pediatric trauma patient
Timothy E Brenkert1, Cynthia Adams1, Rebecca L Vieira1
1Division of Emergency Medicine, Boston Children's Hospital, 300 Longwood Ave, Boston, MA 02115, USA.
Insights
In pediatric trauma patients, the pelvis is the most common site for intraperitoneal free fluid on a FAST exam. The inferior tip of the liver is the next most frequent location outside the pelvis.
Area of Science:
- Pediatric Emergency Medicine
- Diagnostic Imaging
- Trauma Care
Background:
- The Focused Assessment with Sonography for Trauma (FAST) exam is crucial for evaluating blunt abdominal trauma in children.
- Identifying the precise location of intraperitoneal free fluid aids in clinical decision-making and management.
Purpose of the Study:
- To pinpoint the anatomical locations of intraperitoneal free fluid detected by FAST exams in pediatric trauma patients.
- To enhance the diagnostic accuracy and utility of FAST exams in this population.
Main Methods:
- Retrospective review of FAST exams positive for intraperitoneal free fluid in pediatric trauma patients (August 2009 - February 2016).
- Categorization of fluid locations into nine predefined intraperitoneal regions (four in each upper quadrant and the pelvis).
Main Results:
- Of 103 positive FAST exams, 95% showed fluid in the pelvis.
- Free fluid was identified in the right upper quadrant (RUQ) in 35% and the left upper quadrant (LUQ) in 16.5% of patients.
- The inferior tip of the liver was the most common site for fluid outside the pelvis (83.3% of RUQ fluid cases, 29% of all positive FAST exams).
Conclusions:
- The pelvis is the predominant location for intraperitoneal free fluid in pediatric trauma patients with a positive FAST exam.
- Clinicians should pay close attention to the inferior tip of the liver as a frequent site for fluid accumulation outside the pelvis in this demographic.
Objective:
To determine the location of intraperitoneal free fluid on FAST exam in pediatric patients undergoing evaluation for trauma.
Methods:
Retrospective review of all FAST exams positive for intraperitoneal free fluid performed in patients sustaining trauma between August 2009 and February 2016 in an urban pediatric emergency department. Positive results were categorized into one of nine potential intraperitoneal locations; 4 each in the right and left upper quadrants, and the pelvis.
Results:
One hundred and three complete positive studies were reviewed. The median age of patients was 10years (IQR 7-14) with 66% being male. Ninety-five percent had fluid present in the pelvis, 35% had fluid present in the RUQ, and 16.5% had fluid present in the LUQ. Overall, the most frequent location of fluid outside of the pelvis was found at the inferior tip of the liver, present in 83.3% of patients with fluid in the RUQ and 29% of all patients with a positive FAST.
Conclusions:
The majority of pediatric trauma patients with a positive FAST exam will exhibit free fluid in the pelvis. Particular attention should be directed to the inferior tip of the liver in children as this represents the most common location for fluid collection outside the pelvis.
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