Diagnostik des stumpfen Abdominaltraumas des Kindes – ein systematisches Review mit Metaanalyse

 

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Zusammenfassung

Zielsetzung: Das Ziel dieses systematischen Reviews war, die Diagnostik des stumpfen kindlichen Abdominaltraumas zu untersuchen. Methoden: Es wurde eine Literaturrecherche in folgenden Quellen durchgeführt: MEDLINE/Pubmed, Embase und Cochrane. Wo möglich, erfolgte eine Metaanalyse der vorhandenen Daten. Für alle Publikationen wurde die Qualität nach den Oxford-Kriterien ermittelt. Ergebnisse: Indikatoren für eine intraabdominelle Verletzung (IAV) sind erhöhte Transaminasen, ein pathologischer Untersuchungsbefund, ein erniedrigter systolischer Blutdruck, ein reduzierter Hämatokrit und Mikrohämaturie. Der Nachweis einer IAV mittels FAST (focused assessment with sonography for trauma) hatte eine Sensitivität von 56,5 %, eine Spezifität von 94,68 %, eine positive Likelihood Ratio von 10,63 und eine negative Likelihood Ratio von 0,46. Die Genauigkeit lag bei 84,02 %. Bei hämodynamisch instabilen Kindern lagen die Sensitivität und die Spezifität bei 100 %. Die Prävalenz von IAV bei einer negativen abdominellen CT betrug 0,19 %. Der NPV (negative prädiktive Wert) der Abdomen-CT zum Nachweis einer IAV war 99,8 %. Die Laparotomierate bei Kindern mit Nachweis von isolierter freier abdomineller Flüssigkeit (IFF) in einer Region betrug 3,48 %, wohingegen die Laparotomierate bei mehr als einer Region auf 56,52 % anstieg. Schlussfolgerung: FAST hat aufgrund der geringen Sensitivität als alleiniges Diagnostikum nach einem stumpfen Abdominaltrauma bei Kindern eine nur sehr eingeschränkte Aussagekraft. Die ambulante Weiterbehandlung von Kindern nach einem stumpfen Bauchtrauma und einer negativen Abdomen-CT erscheint sicher zu sein. Wenn IFF ohne Nachweis einer IAV in der Abdomen-CT nachgewiesen wird, ist es entscheidend, wie viele Bereiche betroffen sind. Bei einer Region ist eine IAV eher unwahrscheinlich. Ab 2 Regionen steigt die Laparotomierate signifikant an.

Abstract

Objective: The objective of this systematic review was to investigate the diagnostic management in paediatric blunt abdominal injuries. Methods: A literature research was performed using following sources: MEDLINE, Embase and Cochrane. Where it was possible a meta-analysis was performed. Furthermore the level of evidence for all publications was assigned. Results: Indicators for intraabdominal injury (IAI) were elevated liver transaminases, abnormal abdominal examinations, low systolic blood pressure, reduced haematocrit and microhematuria. Detecting IAI with focused assessment with sonography for trauma (FAST) had an overall sensitivity of 56.5 %, a specificity of 94.68 %, a positive likelihood ratio of 10.63 and a negative likelihood ratio of 0.46. The accuracy was 84.02 %. Among haemodynamically unstable children the sensitivity and specificity were 100 %. The overall prevalence of IAI and negative CT was 0.19 %. The NPV of abdominal CT for diagnosing IAI was 99.8 %. The laparotomy rate in patients with isolated intraperitoneal fluid (IIF) in one location was 3.48 % and 56.52 % in patients with IIF in more than one location.Conclusions: FAST as an isolated tool in the diagnostics after blunt abdominal injury is very uncertain, because of the modest sensitivity. Discharging children after blunt abdominal trauma with a negative abdominal CT scan seems to be safe. When IIF is detected on CT scan, it depends on the number of locations involved. If IIF is found only in 1 location, IAI is uncommon, while IIF in two or more locations results in a high laparotomy rate.

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