Assessment Of Blunt Abdominal Trauma Research Articles

Assessment of blunt abdominal trauma in the emergency department: Systematic review

Assessment of blunt abdominal trauma in the emergency department: Systematic review

Contrast-enhanced point of care ultrasound for the evaluation of stable blunt abdominal trauma by the emergency physician: A prospective diagnostic study.

Clinical examination alone cannot reliably rule out significant traumatic abdominal injury. Computed tomography (CT) has become the primary method for evaluating blunt abdominal trauma and clinicians rely heavily on it to rule out abdominal injury. Ultrasound examination may miss significant abdominal injury particularly in stable patients. The use of a contrast agent improves ultrasound sensitivity to visceral abdominal injuries. The objective of this diagnostic study is to compare bedside contrast enhanced ultrasound (CEUS) performed by emergency physicians to CT in hemodynamically stable adults for the assessment of blunt abdominal trauma and evaluate CEUS accuracy outcomes. Hemodynamically stable patients with blunt trauma were prospectively enrolled in the trauma bay. After initial evaluation, we included patients at risk of abdominal injury and for whom an abdominal CT was planned by the trauma leader. Ultrasonography was performed prospectively and at the bedside by the emergency physician followed by abdominal CT used as a reference standard. Thirty-three patients were enrolled in the study; among them, 52% showed positive traumatic findings in abdominal CT scans, and 42% were diagnosed with solid organ lesions. Compared to CT, a focused abdominal sonography (FOCUS) examination, looking for free fluid or perirenal hematoma, showed limited performance for traumatic findings with a sensitivity of 65% (95% confidence interval [CI]: 38%-86%), a specificity of 75% (95% CI: 48%-93%), a negative likelihood ratio (NLR) of 0.47 (95% CI: 0.23-0.95), and a positive likelihood ratio (PLR) of 2.59 (95% CI: 1.03-6.48). When combining FOCUS with CEUS, the sensitivity of the sonography increased to 94% (95% CI: 71%-100%) with a specificity of 75% (95% CI: 48%-93%). The PLR was 3.76 (95% CI: 1.6-8.87) and the NLR was 0.08 (95% CI: 0.01-0.54). In our population, abdominal sonography with contrast failed to identify a single positive abdominal CT with a grade 1 kidney injury. A FOCUS examination shows limited sensitivity and specificity to detect positive abdominal CT in stable adults with abdominal trauma. With the addition of contrast and careful inspection of solid organs, abdominal sonography with contrast performed by the emergency physician improves the ability to rule out traumatic findings on abdominal CT. CEUS performed by emergency physicians may miss injuries, especially in the absence of free fluid, in cases of low-grade injuries, simultaneous injuries, or poor-quality examinations.

Role of Contrast Enhanced CT in Assessment of Blunt Abdominal Trauma in Comparison to Ultrasonography

Background Clinical examination fails to accurately diagnose many intraabdominal injuries in blunt abdomen and hence there is a well need for a good imaging technique.US and CT satisfy this to a great extent. With minimum technical limitations and a short time for examination US and CT become extremely useful in guiding the trauma surgeon. CECT is a highly useful imaging modality for diagnosis of blunt abdominal trauma. However US can be used as a useful initial modality. US and CT grading were of not much impact in the management of liver trauma, however extremely useful in the decision making of renal trauma and to a lesser extent in splenic injuries. CT is excellent in picking up clinically unsuspected trauma especially involving liver, kidney and bowel. Aim of the Work The aim of this study is to define and compare the role of CE-MDCT and FAST in detection of intraabdominal organs’ injuries and hemoperitoneum. And to highlight the value added by CE- MDCT in hemodynamically stable patients providing an accurate and highly sensitive diagnostic method for blunt abdominal trauma. Patients and Methods A prospective study was done in radio diagnosis department in Al Sherouk Police hospitals, and Zagzaig university hospitals-radiology department – ultrasound and CT units. 12 months, from 1/11/2018 to 1/11/2019. Results In this study CT detected 18 cases of splenic trauma compared to US which detected only 10 cases. Of the 8 additional cases detected on CT two were of grade IV injury and required surgery. CE-MDCT detected100% of splenic injuries confirmed clinically/surgically thus has been the gold standard method of detecting splenic injuries. CT detected 41 cases of haemoperitoneum which is 91% among all the cases of blunt injury to the abdomen. Conclusion CT is a superior diagnositic modality in the diagnosis of abdominal trauma.

PECULIARITIES OF FORENSIC MEDICAL ASSESSMENT OF LIVER, SPLEEN AND KIDNEY DAMAGE DURING A FALL FROM HEIGHT

The article reflects the data of an expert assessment of blunt abdominal trauma in a fall from a height. It is especially important to find out the circumstances of the injury in order to have an idea of possible damage to the hollow and parenchymal organs of the abdominal cavity. According to the conducted studies, when falling from a height, characteristic damage was established, depending on the height of the fall.

Role of computed tomography imaging in the diagnosis of blunt and penetrating abdominal trauma injuries

Background: The present study was conducted with the primary aim of evaluating the role of computed tomography imaging in the assessment of blunt abdominal trauma (BAT) and penetrating abdominal trauma injuries. Methods: This prospective study comprised 53 patients with BAT and PAT injuries referred from the emergency department to the department of radio-diagnosis for ultrasonography and CT. Multidetector computed tomography scans were performed on GE Bright Speed Elite 16 slice CT Scanner. The various injuries seen on the CT images were grouped and examined based on the injury site and the organs involved. Results: The majority of the study subjects, i.e., 17/53 (32.08%) belonged age group of 20-30 yrs. Out of the 53 study subjects, 48 had BAT and 5 had PAT. The majority of study subjects who had BAT, i.e., 26/48 RTA, was the cause of trauma, and 5 out of 5 who had PAT assault was the cause of trauma. The most common organ injured was the spleen (18), followed by the liver (17), bowel (15), Anterior abdominal wall (6), pancreas (1), Kidney (1), Uterus (2), Multiple organs (1) and Hemoperitoneum without solid organ injury (1). CT showed 100% accuracy in the diagnosis of abdominal organ injuries. Conclusions: CT imaging plays a pivotal role in the rapid identification of life-threatening injuries and is helpful for prompt initiation of appropriate care, which leads to an increase in the chance of survival of patients with BAT and PAT injuries.

Computed Tomography Evaluation of Blunt Abdominal Injury

Background: Unlike penetrating abdominal trauma, where management is largely determined clinically, the diagnosis of blunt abdominal injury by clinical examination is unreliable, particularly in patients with a decreased level of consciousness.Plain abdominal radiography has limited role in the assessment of blunt abdominal trauma, although some authorities continue to advocate its use. CT scan’s main advantage is the ability to detect arterial contrast extravasation, uncontained or as a pseudoaneurysm, which predicts the need for surgery or angioembolisation. The aim is to study computed tomography evaluation of blunt abdominal injury. Subjects and Methods: The present study was conducted in the Department of Radiology of the medical institution. For the study, we used abdomen CT scan reports of 100 patients with BAT, who were stable enough to undergo radiological investigation. The patients included 66 males and 34 females. All CT scans were obtained with a 16 slice MDCT Scanner (Siemens). All patients received intravenous bolus of iodinated contrast agents. Individual organ injuries were graded according to the American Association for the Surgery of Trauma (AAST - OIS) injury scoring scale. The overall imaging findings were analysed for their role in guiding the therapeutic options, whether conservative or surgical. Results: Total number of patients included in the study was 100. The mean age of patients was 41.97 years. Number of male patients was 66 and number of female patients was 34. For the mode of injury, other miscellaneous causes were most common in out study group followed by road traffic accidents. It was observed that OIS grade II patients were 19, OIS grade III patients were 29, OIS grade IV patients were 12 and OIS grade V patients were 10. The highest proportion of conservatively managed patients were seen in OIS grade II patients. Conclusion: Within the limitations of the present study, it can be concluded that CT scan for blunt abdominal injury is a reliable and accurate method for diagnosis. It has all the qualities to make it a gold standard for initial investigation of choice for blunt abdominal injury patients.

Role of Multi-Detector Computed Tomography in Assessment of Blunt Abdominal Trauma in Pediatric Patients

Abstract Background: Abdominal trauma in pediatrics is common. The delay in diagnosis and treatment could increase the complications rate. Using Computed tomography (CT) has been the gold standard in assessment of hemodynamically stable patients with blunt abdominal trauma. Aim of Study: Was to identify the value of the MDCT in the assessment of different abdominal injuries as a result of blunt abdominal trauma in pediatricpatients. Patient and Methods: This prospective study carried out on 50 pediatric patients with blunt abdominal trauma, those patients underwent multi-detector CT abdomen with intrave-nous contrast for detection of intra-abdominal injuries. This study was conducted between October 2018 and October 2019. The data collected were tabulated and analyzed statis-tically. Results: MDCT study of pediatric patients was able to diagnose and grade solid and non-solid organ injuries. The spleen was the most commonly injured solid organ (56%) followed by the liver (46%) and kidney (32%). MDCT findings were able to limit the need for surgical intervention, where most of the cases were managed conservatively. Conclusions: MDCT candetect and accurately assess the grading of injuries of solid organs, non-solid hollow viscus organs. Also it perfectly diagnoses diaphragmatic injuries and bone fractures. Vascular and non-vascular complications were diagnosed accurately with triphasic contrast enhanced CT protocol. MDCT is of a great help in deciding the mostpref-erable management by detecting life-threatening conditions such as the active bleeding. Also, it primarily suggests non-operative management protocol as the intensity of care and the hospital stay duration.

Clinical value of bedside abdominal sonography performed by certified sonographer in emergency evaluation of blunt abdominal trauma

PurposeTo investigate the accuracy and efficiency of bedside ultrasonography application performed by certified sonographer in emergency patients with blunt abdominal trauma. MethodsThe study was carried out from 2017 to 2019. Findings in operations or on computed tomography (CT) were used as references to evaluate the accuracy of bedside abdominal ultrasonography. The time needed for bedside abdominal ultrasonography or CT examination was collected separately to evaluate the efficiency of bedside abdominal ultrasonography application. ResultsBedside abdominal ultrasonography was performed in 106 patients with blunt abdominal trauma, of which 71 critical patients received surgery. The overall diagnostic accordance rate was 88.68%. The diagnostic accordance rate for liver injury, spleen injury, kidney injury, gut perforation, retroperitoneal hematoma and multiple abdominal organ injury were 100%, 94.73%, 94.12%, 20.00%, 100% and 81.48%, respectively. Among the 71 critical patients, the diagnostic accordance rate was 94.37%, in which the diagnostic accordance rate for liver injury, spleen injury, kidney injury, gut perforation and multiple abdominal organ injury were 100%, 100%, 100%, 20.00% and 100%. The mean time for imaging examination of bedside abdominal ultrasonography was longer than that for CT scan (4.45 ± 1.63 vs. 2.38 ± 1.19) min; however, the mean waiting time before examination (7.37 ± 2.01 vs. 16.42 ± 6.37) min, the time to make a diagnostic report (6.42 ± 3.35 vs. 36.26 ± 13.33) min, and the overall time (17.24 ± 2.33 vs. 55.06 ± 6.96) min were shorter for bedside abdominal ultrasonography than for CT scan. ConclusionBedside ultrasonography application provides both efficiency and reliability for the assessment of blunt abdominal trauma. Especially for patients with free peritoneal effusion and critical patients, bedside ultrasonography has been proved obvious advantageous. However, for negative bedside ultrasonography patients with blunt abdominal trauma, we recommend further abdominal CT scan or serial ultrasonography scans subsequently.

Duodenal Perforation following Blunt Abdominal Trauma Presenting as Normal in Abdominal Computed Tomography

Most emergency department (ED) physicians implement the Advanced Trauma Life Support (ATLS) approach, including primary and secondary survey, for the assessment of blunt abdominal trauma (BAT) patients. This report emphasizes the need for repeat Focused Assessment with Sonography for Trauma (FAST) and abdominal computed tomography (CT) if a BAT patient's condition persists or worsens. After initial negative FAST and abdominal CT findings, it is recommended that BAT patients with suspected intraabdominal injury should receive repeat examination in an optimal time. We report a patient who sustained duodenal perforation following BAT diagnosed by repeat ultrasound examination and abdominal CT scan. (Hong Kong j.emerg.med. 2014;21:396-399)

Contrast-enhanced ultrasound in abdominal trauma

Increasing evidence supports a role for contrast-enhanced ultrasound in the assessment of blunt abdominal trauma. Accurate definition of organ injury can be demonstrated, as well as extension to solid organ capsule and even vascular injury. Low-dose contrast is needed for renal imaging, to avoid obscuration of deeper structures from intense cortical enhancement. The liver should be evaluated in the arterial phase for active bleeding and in the late phase for lacerations. The spleen is best assessed in the delayed phase, thereby limiting misinterpretation of early heterogeneous contrast uptake. Typical sonographic features of traumatic injuries of the solid abdominal organs are described. Although contrast-enhanced computed tomography is the gold standard modality for imaging abdominal organ traumatic injury, contrast-enhanced ultrasound has developed a role in the emergency setting, particularly in low-energy injuries and in follow-up of traumatic injuries.

Is the FAST exam reliable in severely injured patients?

Introduction Highly sensitive and accurate for the detection of injuries requiring intervention in haemodynamically unstable patients, FAST may underestimate intra-abdominal injuries in stable patients with blunt abdominal trauma. Diminished accuracy of ultrasound has been reported in different cohorts of multiple injured patients. We hypothesised that multiple injured patients with a high Injury Severity Score (ISS) will have a decreased accuracy of FAST for the assessment of blunt abdominal trauma. Methods Data from the trauma registry of a Level 1 trauma centre were retrospectively reviewed. All haemodynamically stable blunt trauma patients who underwent both FAST and CT scan of abdomen from January 1, 2000 to January 1, 2005 were included in the cohort. All patients were divided into three groups according to their ISS: Group 1 included patients with an ISS from 1 to 14, Group 2 included patients with an ISS from 16 to 24, and Group 3 consisted of patients with ISS ≥ 25. Results 3181 patients with blunt abdominal trauma included into the study were divided into the three groups according to the ISS. The mean ISS was 7.9 ± 3.97, 19.6 ± 2.48 and 41.3 ± 11.95 in Groups 1, 2 and 3, respectively. The accuracy of ultrasound was 90.6% in the group of patients with the highest ISS (≥25) compared with 97.5 and 97.1 for Groups 1 and 2 ( p < 0.001). Similarly, ultrasound had a significantly lower sensitivity, specificity, PPV and NPV for patients in Group 3 compared with the first two groups ( p < 0.001). There was a significantly lower sensitivity in Group 2 compared with Group 1 ( p < 0.001), but no differences in specificity, accuracy, PPV or NPV were demonstrated. Conclusion Patients with high ISS are at increased risk of having ultrasound-occult injuries and have a lower accuracy of their ultrasound examination than patients with low and moderate ISS.

The EFSUMB guidelines for contrast-enhanced ultrasound are comprehensive and informative for good clinical practice: will radiologists take the lead?

A study group organized by the European Federation of Societies of Ultrasound in Medicine and Biology (EFSUMB) has issued an up-to-date set of guidelines on the clinical application of contrast-enhanced ultrasound (CEUS) [1]. The first set of guidelines for the application of contrast agents to the practice of ultrasound were published in 2004 [2], and the present set of guidelines are directed towards those not intimately involved in the field, whose perception is that rapid advances in technology and techniques can be difficult to follow, as well as experienced users of CEUS. The initial guidelines concentrated on CEUS applications in the liver, but the present guidelines recognize the expanding role of CEUS and include recommendations for its use in (i) the kidney, (ii) vesicoureteric reflux, (iii) the pancreas, (iv) trauma and (v) the cerebral circulation. The guidelines include good clinical practice recommendations for the use of CEUS, and are exceptionally comprehensive without being lengthy. Detailed descriptions of the procedure techniques, the interpretation of findings and its limitations are included. The study group readily acknowledge the shortcomings of a CEUS examination; these are the exact limitations that occur with all ultrasound examinations. When the baseline ultrasound examination is disappointing, then the CEUS examination is also likely to disappoint — an important caveat for those incorporating techniques of CEUS into their practice. Recommendations for investigator training are also included, with the likelihood that practitioners of CEUS would need to have attained at least a Level 2 of competency, if not higher. Currently, there are four agents licensed for use in Europe: Levovist (Schering, Berlin, Germany), Optison (GE Healthcare, Oslo, Norway), Definity (BristolMeyers Squibb, Uxbridge, UK) and SonoVue (Bracco, Milan, Italy).The sole indication to date for Optison and Luminity is for cardiac use. Practitioners in Japan have the advantage of access to another agent: Sonazoid (GE Healthcare, Oslo, Norway). Levovist, the oldest agent (having been introduced in 1996), is not sufficiently robust to be used adequately with the newer low mechanical index (MI) techniques. It does, however, have the characteristic of late phase ‘‘trapping’’ in the liver, a feature not demonstrated by some of the newer agents (except for Sonazoid) but which has been exploited to good effect in the past [3]. Current recommendations do not promote the use of high MI techniques to investigate liver lesions in the late phase, citing technical difficulties [1]. As a consequence, the most widely used agent currently for radiological indications in Europe is SonoVue This agent is particularly suited for the low MI techniques for the detection and characterization of focal liver lesions, with studies indicating that CEUS is as good, if not better, than contrast-enhanced CT [4, 5]. With CEUS, a ‘‘black hole’’ at the end of the portal venous phase almost always indicates a secondary malignant lesion (if a cyst has been excluded on the baseline examination) [1]. The usefulness of CEUS is not in doubt. Many new applications outside the traditional investigation of parenchymal liver lesions have developed or are evolving, with assessment of blunt abdominal trauma in the emergency room being particularly attractive [6]. The establishment of a standard CEUS ‘‘Bosniak’’ classification of renal cysts is also a possibility [7]. The list of useful applications grows as more investigators report their findings; however, the technique has not been fully embraced by the radiological community, despite the proven usefulness of CEUS. Uptake is slow, particularly in the UK, although ‘‘hot spots’’ exist. The European radiological community shows more interest in the use of CEUS, particularly in Italy. Japan and China are driving clinical practice with CEUS. However, there is a Address correspondence to: Paul S Sidhu, Department of Radiology, King’s College Hospital, Denmark Hill, London SE5 9RS, UK. E-mail: paul.sidhu@kch.nhs.uk The British Journal of Radiology, 81 (2008), 524–525

Contrast-Enhanced Ultrasound for Blunt Abdominal Trauma

Sonography is widely used in the initial diagnostic assessment of blunt abdominal trauma in adults and children. It has been formally incorporated worldwide into the routine armamentarium available for emergency diagnosis and treatment as a means of rapid detection of free abdominal fluid, normally referred to as FAST (Focused Assessment with Sonography in Trauma). However, there is some controversy regarding its value because free abdominal fluid may be lacking in patients with abdominal organ injuries from blunt trauma. More recently, a new ultrasound technique has been developed using contrast agents. Contrast-enhanced ultrasound performs better than the non-contrast-enhanced technique for the detection of abdominal solid organ injuries and can play an important role in the prompt evaluation of patients with blunt trauma. Furthermore, contrast-enhanced ultrasound can be used in the follow-up of patients who have solid organ lesions and are managed with nonoperative treatment, avoiding radiation and iodinated contrast medium exposure.

Blunt Abdominal Trauma: Emergency Contrast-Enhanced Sonography for Detection of Solid Organ Injuries

The objective of our study was to prospectively compare the diagnostic value of sonography and contrast-enhanced sonography with CT for the detection of solid organ injuries in blunt abdominal trauma patients. Sonography, contrast-enhanced sonography, and CT were performed to assess possible abdominal organ injuries in 69 nonconsecutive hemodynamically stable patients with blunt abdominal trauma and a strong clinical suspicion of abdominal lesions. Sonography and contrast-enhanced sonography findings were compared with CT findings, the reference standard technique. Thirty-two patients had 35 abdominal injuries on CT (10 kidney or adrenal lesions, seven liver lesions, 17 spleen lesions, and one retroperitoneal hematoma). Sixteen lesions were detected on sonography, and 32 were seen on contrast-enhanced sonography. The sensitivity and specificity of sonography were 45.7% and 91.8%, respectively, and the positive and negative predictive values were 84.2% and 64.1%, respectively. Contrast-enhanced sonography had a sensitivity of 91.4%, a specificity of 100%, and positive and negative predictive values of 100% and 92.5%, respectively. Contrast-enhanced sonography was found to be more sensitive than sonography and almost as sensitive as CT in the detection of traumatic abdominal solid organ injuries. It can therefore be proposed as a useful tool in the assessment of blunt abdominal trauma.

Experience with focused abdominal sonography for trauma (FAST) in 313 pediatric patients.

The use of focused abdominal sonography for trauma (FAST), which detects free fluid in the abdomen and pelvis, for the assessment of blunt abdominal trauma is gaining acceptance worldwide and has been described extensively in the general medical literature. The precise application of this technique in pediatric patients, however, has yet to be established. The aim of this study was to assess the utility of FAST in pediatric trauma patients by comparing the results of this technique with those of CT and explorative laparotomy (ELAP). We retrospectively reviewed the medical records and sonographic examinations of pediatric patients who had sustained multiple traumatic injuries for which they were treated at our hospital during a 20-month period. For all patients, FAST had been the initial screening examination for blunt abdominal trauma. We compared the FAST findings, which had been recorded as positive or negative, with the findings on CT or ELAP, which were considered definitive. A total of 313 patients (204 boys and 109 girls) with a mean age of 7.1 years were included in the study. The FAST finding had been negative in 274 patients, of whom 201 had had no clinical signs of abdominal injury and had been managed conservatively without complications. CT had been performed in 109 patients and ELAP in 11. FAST had yielded 3 false-negative and 2 false-positive results. The sensitivity, specificity, and accuracy of FAST were 92.5%, 97.2%, and 95.5%, respectively. FAST is an effective tool in screening pediatric trauma patients for blunt abdominal trauma.

Sonographic assessment of blunt abdominal trauma: A 4‐year prospective study

Sonographic assessment of blunt abdominal trauma: A 4‐year prospective study

Ultrasound in the emergency department: Emergency department ultrasound for the assessment of abdominal trauma: an overview

Diagnostic ultrasound (U/S) has been used in medicine for over 40 years, and reports describing the use of abdominal U/S in trauma date back to 1971. Recently, however, trauma ultrasonography has become a controversial issue in Canada. U/S provides the speed and accuracy we associate with diagnostic peritoneal lavage (DPL) in a noninvasive format. It is safe, inexpensive, repeatable, accessible at the bedside, and requires little patient preparation. U/S is now the initial test for the assessment of blunt abdominal trauma in most European and Australasian centres. More recently U/S has become common in US trauma centres.

Usefulness and limitations of ultrasonography in the initial evaluation of blunt abdominal trauma.

In the assessment of blunt abdominal trauma, the reliability of ultrasonography (US) in identifying individual organ injuries remains uncertain, in spite of its usefulness in detecting hemoperitoneum. This study was designed to evaluate the overall diagnostic value of US, including identification of individual organ injuries. The accuracy of US in the detection of intra-abdominal injuries and the identification of individual organ injuries was evaluated in 1,239 patients seen during a 15-year period. Accuracy was based on detection of intraperitoneal fluid, free air, or irregular parenchymal lesions. For the detection of injuries, US was 94.6% sensitive, 95.1% specific, and 94.9% accurate. Individual organ injuries were identified with sensitivities of 92.4, 90.0, 92.2, 71.4, and 34.7% for the liver, spleen, kidneys, pancreas, and intestine, respectively. US is reliable for the detection of injuries and the identification of solid-organ injuries despite its poor sensitivity for intestinal injuries.

Sonography as the primary screening technique for blunt abdominal trauma: experience with 899 patients.

The purpose of this study was to determine the accuracy of sonography when used routinely as the primary screening technique for blunt abdominal trauma. From December 1994 through December 1995, we used sonography as the primary screening technique for the initial assessment of blunt abdominal trauma. Sonography was performed by dedicated technologists and overseen and interpreted by radiology residents or attending physicians. A positive study was defined as evidence of free fluid or parenchymal injury. Sonographic findings were correlated with CT, surgery, or clinical follow-up. Of the 899 sonograms obtained for blunt abdominal trauma, the findings of 783 were negative, 101 were positive, and 15 were indeterminate. Of the 783 sonograms with negative findings, 768 (98%) were confirmed by CT, surgery, or clinical follow-up. Similarly, of the 101 sonograms with positive findings, 95 (94%) were confirmed. Interpretations resulted in 15 false-negative and five false-positive examinations. For all sonograms, we calculated a sensitivity of 86%, a specificity of 99%, and an accuracy of 98%. Sonography can be used effectively as the primary screening technique for blunt abdominal trauma.

Comparison of computed tomography and ultrasonographic imaging in the assessment of blunt abdominal trauma in children

Computed tomography (CT) has become established in the assessment of paediatric blunt abdominal trauma. However, advances in diagnostic imaging necessitate reassessment of the role of available diagnostic modalities. Experience at a paediatric teaching hospital over a 5-year period was reviewed, with direct comparison of CT against ultrasonographic imaging in 26 children presenting with acute blunt abdominal trauma. Intra-abdominal injury was diagnosed by CT in 23 of 24 patients compared with 21 on ultrasonography, although ultrasonography identified organ-specific injury in only 12 of 24 patients. CT was superior in the assessment of the multiply injured child, and identified spinal and pelvic injuries in three patients. CT augmented plain chest radiography in ten patients with associated thoracic injuries. CT is the imaging modality of choice in children with severe abdominal trauma but ultrasonography is a reasonable technique to arouse diagnostic suspicion in less severe injuries or where CT is unavailable or delayed.