Pediatric ultrasound

Pediatric FAST and E-FAST

• Pediatric FAST exam less sensitive than in adults because more pediatric abdominal injuries do not have associated free fluid.

Sensitivity 66%. Specificity 95%. Some advocate combining FAST with LFTs (improved sensitivity to 88%) or FAST and observed for 6 hours. Future of FAST may include ultrasound with intravenous contrast. Procedurally is similar to adult FAST and E-FAST

Pediatric Skull Ultrasound

• Absence of skull fracture doesn't rule out intracranial injury but can be used to risk stratify.

Sensitivity of 94%-100%. Specificity of 95%-96%. (albeit less literature on this topic) Skull x-rays have sensitivity 38% and specificity of 95%

Procedure

Place probe on area with maximal tenderness, hematoma, or other sign of possible fracture. Scan in 2 planes. Look for disruptions in cortex. Sutures can be identified by following cortical break to a fontanelle and/or comparing contralateral side. Fractures will have ragged, sharp margins. Sutures will have smooth appearance.