Contrast enhanced ultrasound has been used clinically in Europe for the past 10 years as an evaulation tool for examining abdominal injuries in trauma among children and adults. This is a valuable diagnostic modality that could potentially reduce the need for radiation exposure from abdominal computed tomography (CT) scans in trauma evaluation. The research protocol aims to compare the utility of Optison(GE Healthcare, Princeton, NJ) contrast enhanced abdominal sonography with computerized tomography in the evaluation of children with suspected blunt abdominal trauma. Hemodynamically stable children ages 10-18 who are transferred to Children's Hospital on the trauma service with a CT scan of abdomen & pelvis already performed at the referring institution will be identified by the trauma service as eligible for inclusion. Children who are hemodynamically unstable, known cardiac abnormality, unable to roll over, or unable to assent will be excluded from the study. A project clinical nurse will discuss enrollment in the study and obtain consent from the parent. If the child is enrolled in the study, he/she will have a non contrast ultrasound, followed by a contrast enhanced ultrasound performed in the Radiology Department once he/she is stabilized and evaluation is completed in the Emergency Room. The patient will have vital signs (including blood pressure, heart rate, respiratory rate, oxygen saturation) monitored during the study and 30 minutes after contrast administration.
The ultrasounds will be performed by one of two Attending Radiologists involved in the study. The second Radiologist not performing the study will also provide a second read of the ultrasounds. They will not have access to the results of the CT scans that were performed prior to patient transfer, nor any other clinical data. The contrast being used for the study is Optison (GE Healthcare Inc, Princeton, NJ), which is an injectable suspension of Perflutren Protein-Type A Microspheres. This has been used in echocardiography as well as abdominal ultrasonography for evaluation of pediatric abdominal and pelvic solid tumors. After the non contrast ultrasound is performed, the project clinical nurse will administer Optison contrast agent via peripheral IV. The contrast enhanced ultrasound will be performed by radiologist. Contrast enhancement only lasts for 3-5 minutes per injection, therefore Optison will be redosed up to 2 additional doses for the completion of the ultrasound. Vital signs will be monitored for 30 minutes after the contrast agent is given and any adverse reactions will be recorded. Adverse reactions to Optison have occurred within this time frame in the literature. Adverse reactions reported include transient headache, rash, vasovagal reaction, transient desaturation, anaphylaxis. After completion of the ultrasounds the patient will be transported to the surgical floor for admission to the hospital. Subsequent medical care will be as indicated per the clinical practice guideline.