Diagnostic imaging in pediatric trauma.

In the head and neck, the futility of skull radiography is again reemphasized as a poorer predictor of intracranial injury than is a neurologic examination, though controversy continues as to which neurologic criteria should be the ones leading to a cranial computed tomography scan. Understanding the anatomic variations in the radiography of the cervical spine in small infants and children can help avoid overdiagnosis in this group and can obviate the need for additional unwarranted computed tomography studies and undue clinical concern. Magnetic resonance imaging can show anatomically exquisite portrayals of growing skull fractures for neurosurgical planning, but its routine use for imaging the cervical cord in shaken, abused infants without clinical abnormality appears unwarranted. Within the chest, the radiograph remains a highly accurate and low cost cornerstone in traumatized patients. The use of ultrasound imaging to detect pleural fluid is being investigated and has been found to be accurate but cannot compare to all of the information gleaned from the radiograph. The pericardium is clearly an exception. Abdominal trauma in children is triaged vastly differently from that of adults. Imaging of adults looks for signs to diagnose significant bleeding and need for operation, while pediatric trauma imaging has its greatest effect in reducing the intensity of care. Administration of oral contrast has not been very effective in aiding diagnosis of hollow visceral perforations and is being used less in blunt abdominal trauma computed tomography. Children with microscopic hematuria and no evidence of multiple system trauma seem to be helped little by imaging. The utility of finding and extracting subcutaneous foreign material, usually in extremities, by ultrasound imaging remains controversial. Experience, equipment, and effort all seem to play a role.

Transabdominal manually assisted reduction of pediatric intussusception: reappraisal of this historical technique.

PURPOSE: To determine whether manual manipulation of the abdomen during intussusception reduction improves the success rate or affects morbidity. MATERIALS AND METHODS: A retrospective study was performed in 38 cases of intussusception in 35 children over a 33-month period at a pediatric hospital. In all cases, pneumostatic pressure was used as the initial method of treatment. A comparative review of the intussusception literature was also performed. RESULTS: Reduction was achieved with pneumostatic pressure alone in 22 cases (an initial success rate of 58%). Transabdominal manual manipulation was used in 10 cases after initial pneumostatic reduction failed; seven of these 10 cases were treated successfully. These seven additional successes, attributed to manual assistance, significantly improved the success rate from 58% to 76% (P < .016). No perforation or other complication occurred. CONCLUSION: These results and findings of the literature review indicate that transabdominal manual assistance during reduction is a potentially useful technique that has been shunned without scientific basis for longer than 40 years.