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Contrast-enhanced ultrasound in pediatric blunt abdominal trauma: a systematic review

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Abstract

Purpose

Intra-abdominal injury is a major cause of morbidity in children. Computed tomography (CT) is the reference standard for the evaluation of hemodynamically stable abdominal trauma. CT has an increased risk of long-term radiation induced malignancies and a possible risk associated with the use of iodinated contrast media. Contrast-enhanced ultrasound (CEUS) might represent an alternative to CT in stable children with blunt abdominal trauma (BAT). Nonetheless, CEUS in pediatrics remains limited by the lack of strong evidence. The purpose of this study was to offer a systematic review on the use of CEUS in pediatric abdominal trauma.

Methods

Electronic search of PubMed, EMBASE and Cochrane databases of studies investigating CEUS for abdominal trauma in children. The risk of bias was assessed using the ROBINS-I tool.

Results

This systematic review included 7 studies. CEUS was performed with different ultrasound equipment, always with a curvilinear transducer. Six out of seven studies used a second-generation contrast agent. No immediate adverse reactions were reported. The dose of contrast agent and the scanning technique varied between studies. All CEUS exams were performed by radiologists, in the radiology department or at the bedside. No standard training was reported to become competent in CEUS. The range of sensitivity and specificity of CEUS were 85.7 to 100% and 89 to 100%, respectively.

Conclusion

CEUS appears to be safe and accurate to identify abdominal solid organ injuries in children with BAT. Further research is necessary to assess the feasibility of CEUS by non-radiologists, the necessary training, and the benefit-cost ratio of CEUS as a tool to potentially reduce CT scans.

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Acknowledgements

We gratefully acknowledge Marco Dardi Eng, Clinical & Sales Application, Medical Care System for his technical support and critical advice in reviewing the manuscript.

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Authors and Affiliations

  1. Department of Health Science, University of Florence, Florence, Italy

    Francesco Pegoraro

  2. Department of Emergency Medicine and Trauma Center, Meyer University Children’s Hospital, Florence, Italy

    Giulia Giusti, Martina Giacalone & Niccolò Parri

Authors
  1. Francesco Pegoraro
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  2. Giulia Giusti
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  3. Martina Giacalone
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  4. Niccolò Parri
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Contributions

FP performed the literature search and screened the literature, performed the analysis and the risk of bias assessment, drafted the initial manuscript, and reviewed and revised the manuscript. GG performed the literature search and screened the literature, performed the analysis and the risk of bias assessment, drafted the initial manuscript, and reviewed and revised the manuscript. MG coordinated and supervised data collection, critically reviewed and revised the manuscript, and overviewed the revisions of the manuscript. NP conceptualized and designed the study, drafted the initial manuscript, reviewed the risk of bias assessment, and reviewed and revised the manuscript. All authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.

Corresponding author

Correspondence to Niccolò Parri.

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None declared.

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The need for ethical approval was waived by the local Clinical Trial Center due to the nature of the study.

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Pegoraro, F., Giusti, G., Giacalone, M. et al. Contrast-enhanced ultrasound in pediatric blunt abdominal trauma: a systematic review. J Ultrasound 25, 419–427 (2022). https://doi.org/10.1007/s40477-021-00623-6

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  • DOI: https://doi.org/10.1007/s40477-021-00623-6

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