Assessment of the informativeness of ultrasonography for determination of the volume of hemoperitoneum in children

In the field of pediatric trauma, the question of the optimal approach to diagnosing the volume of hemoperitoneum and calculating blood loss in injuries to the abdominal organs is of important clinical significance. Aim. To develop an ultrasound diagnostic method to accurately determine the volume of free fluid in the abdominal cavity and study its informative value in children with hemoperitoneum. Material and methods. To calculate the volume of free fluid during echosonography, an experiment was conducted on cadaver material (10 victims). To simulate hydroperitoneum, a drainage was installed in the epigastrium using a puncture method, through which an isotonic solution was injected into the peritoneal cavity in portions. Subsequently, ultrasound was performed and correction factors were calculated. The assessment of the informativeness of the ultrasound diagnostic method was carried out based on the results of a one-time analysis of 47 case histories of patients with splenic rupture and hemoperitoneum who were treated from January 1997 to September 2009. Results. In an experiment on cadaver material, a comparison between the true volume and the obtained volume according to echosonography revealed a significant (p = 0.008) difference of 400 (100; 600) ml and 139 (21; 355) ml, respectively. To optimize the calculation of the volume of free fluid according to ultrasound data, correction factors were calculated, which were 2.36 for low hydroperitoneum (up to 11 ml/kg); 1.37 for moderate (11–22 ml/kg) and 1.04 for large (more than 22 ml/kg). In the clinical group, the information content of ultrasound was assessed using the obtained correction factors and body surface area. It was revealed that the resulting formula has high diagnostic tests (sensitivity 93–100%; specificity 88.2–97.7%) for the true calculation of hemoperitoneum volume in children. Conclusion. In children, when performing abdominal echosonography using correction factors, it is possible to calculate with high accuracy the true volume of bloodshed, which is necessary for assessing blood loss. Our results allow us to contribute to the optimization of diagnostic procedures and improve our understanding in assessing the exact volume of hemoperitoneum in the context of abdominal injuries.