***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
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    Input: Diagnostic peritoneal lavage ( DPL ) and computed tomography ( CT ) are the primary diagnostic modalities in the evaluation of patients with suspected blunt abdominal trauma ( BAT ) . Diagnostic peritoneal lavage is fast and accurate but associated with complications . Computed tomography is also accurate , yet requires that patients be stable and transportable . A prospect i ve study was design ed to determine the utility of emergency ultrasound ( US ) studies in the initial assessment of BAT . Two hundred acutely injured patients with suspected BAT were evaluated with US . Patients were eligible for the study if they met trauma criteria and had suspected BAT . Subsequently , without knowledge of the US results , DPL or CT was performed . Ultrasound showed a sensitivity of 83 % , a specificity of 100 % , and an accuracy of 97 % in detecting intra-abdominal injuries . Six injuries were missed but only one was felt to be significant . If US had been used in all 200 patients , 199 would have had appropriate care . We conclude US is reliable in the detection of free intraperitoneal fluid and may be used in place of DPL or CT Background The initial management of a trauma patient is a critical and dem and ing period . The use of extended focused assessment sonography for trauma ( eFAST ) has become more prevalent in trauma rooms , raising questions about the real “ added value ” of chest X-rays ( CXRs ) and pelvic X-rays ( PXR ) , particularly in haemodynamically stable trauma patients . The aim of this study was to evaluate the effectiveness of a management protocol integrating eFAST and excluding X-rays in stable trauma patients . Methods This was a prospect i ve , interventional , single-centre study including all primary blunt trauma patients admitted to the trauma bay with a suspicion of severe trauma . All patients underwent physical examination and eFAST ( assessing abdomen , pelvis , pericardium and pleura ) before a whole-body CT scan ( WBCT ) . Patients fulfilling all stability criteria at any time in transit from the scene of the accident to the hospital were managed in the trauma bay without chest and PXR . Results Amongst 430 patients , 148 fulfilled the stability criteria ( stability criteria group ) of which 122 ( 82 % ) had no X-rays in the trauma bay . No diagnostic failure with an immediate clinical impact was identified in the stability criteria group ( SC group ) . All cases of pneumothorax requiring chest drainage were identified by eFAST associated with a clinical examination before the WBCT scan in the SC group . The time spent in the trauma bay was significantly shorter for the SC group without X-rays compared to those who received any X-ray ( 25 [ 20 ; 35 ] vs. 38 [ 30 ; 60 ] min , respectively ; p < 0.0001 ) . An analysis of the cost and radiation exposure showed savings of 7000 Є and 100 mSv , respectively . Conclusions No unrecognized diagnostic with a clinical impact due to the lack of CXR and PXR during the initial management of stable trauma patients was observed . The eFAST associated with physical examination provided the information necessary to safely complete the WBCT scan . It allowed a sensible cost and radiation saving OBJECTIVES To assess the utility of an existing ultrasound machine for the purpose s of focused assessment sonography in trauma ( FAST ) scanning in a developing world emergency department ( ED ) . DESIGN Prospect i ve study undertaken over a 12-month period . Trauma patients attending the ED were FAST scanned by one of three trained emergency medicine doctors . SETTING The ED at a government hospital in rural KwaZulu-Natal ( KZN ) , the referral centre for 22 peripheral hospitals . SUBJECTS All patients presenting to the ED who had sustained abdominal or thoracic trauma . OUTCOME MEASURES Scans were recorded as positive or negative for free intra-abdominal or pericardial fluid . All results were confirmed by computed tomography , laparotomy or a second trained ED ultrasonographer , followed by a period of clinical observation . RESULTS 72 FAST scans were included , 52 for blunt trauma and 20 for penetrating trauma . Of the 72 scans , 15 ( 20.8 % ) were positive . FAST scanning had 100 % specificity and overall sensitivity of 71.4 % . When considering blunt trauma alone the sensitivity improved to 81.3 % , while in penetrating trauma it was much poorer ( 62.5 % ) . CONCLUSIONS We propose a valuable role for FAST scanning in all peripheral hospitals for the assessment of patients sustaining blunt trauma . In rural areas with limited re sources FAST scans may assist in the appropriate timely transfer of trauma patients for further imaging or definitive surgical intervention INTRODUCTION Blunt abdominal trauma is a common problem in children .  Computed tomography ( CT ) is the gold st and ard for imaging in pediatric blunt abdominal trauma , however up to 50 % of CTs are normal and CT carries a risk of radiation-induced cancer . Contrast enhanced ultrasound ( CEUS ) may allow accurate detection of abdominal organ injuries while eliminating exposure to ionizing radiation . METHODS Children aged 7 - 18years with a CT-diagnosed abdominal solid organ injury underwent grayscale/power Doppler ultrasound ( conventional US ) and CEUS within 48h of injury . Two blinded radiologists underwent a brief training in CEUS and then interpreted the CEUS images without patient interaction . Conventional US and CEUS images were compared to CT for the presence of injury and , if present , the injury grade . Patients were monitored for contrast-related adverse reactions . RESULTS Twenty one injured organs were identified by CT in eighteen children .  Conventional US identified the injuries with a sensitivity of 45.2 % , which increased to 85.7 % using CEUS . The specificity of conventional US was 96.4 % and increased to 98.6 % using CEUS . The positive predictive value increased from 79.2 % to 94.7 % and the negative predictive value from 85.3 % to 95.8 % . Two patients had injuries that were missed by both radiologists on CEUS . In a 100 kg , 17year old female , a grade III liver injury was not seen by either radiologist on CEUS . Her accompanying grade I kidney injury was not seen by one of the radiologist on CEUS . The second patient , a 16year old female , had a grade III splenic injury that was missed by both radiologists on CEUS . She also had an adjacent grade II kidney injury that was seen by both . Injuries , when noted , were grade d within 1 grade of CT 33/35 times with CEUS . There were no adverse reactions to the contrast . CONCLUSION CEUS is a promising imaging modality that can detect most abdominal solid organ injuries in children while eliminating exposure to ionizing radiation . A multicenter trial is warranted before widespread use can be recommended . LEVEL OF EVIDENCE Level II ; Diagnostic Prospect i ve Study BACKGROUND Supine anteroposterior ( AP ) chest radiography may not detect the presence of a small or medium pneumothorax ( PTX ) in trauma patients . OBJECTIVES To compare the sensitivity and specificity of bedside ultrasound ( US ) in the emergency department ( ED ) with supine portable AP chest radiography for the detection of PTX in trauma patients , and to determine whether US can grade the size of the PTX . METHODS This was a prospect i ve , single-blinded study with convenience sampling , based on research er availability , of blunt trauma patients at a Level 1 trauma center with an annual census of 75,000 patients . Enrollment criteria were adult trauma patients receiving computed tomography ( CT ) of the abdomen and pelvis ( which includes lung windows at the authors ' institution ) . Patients in whom the examination could not be completed were excluded . During the initial evaluation , attending emergency physicians performed bedside trauma US examinations to determine the presence of a sliding lung sign to rule out PTX . Portable , supine AP chest radiographs were evaluated by an attending trauma physician , blinded to the results of the thoracic US . The CT results ( used as the criterion st and ard ) , or air release on chest tube placement , were compared with US and chest radiograph findings . Sensitivities and specificities with 95 % confidence intervals ( 95 % CIs ) were calculated for US and AP chest radiography for the detection of PTX , and Spearman 's rank correlation was used to evaluate for the ability of US to predict the size of the PTX on CT . RESULTS A total of 176 patients were enrolled in the study over an eight-month period . Twelve patients had a chest tube placed prior to CT . Pneumothorax was detected in 53 ( 30 % ) patients by US , and 40 ( 23 % ) by chest radiography . There were 53 ( 30 % ) true positives by CT or on chest tube placement . The sensitivity for chest radiography was 75.5 % ( 95 % CI = 61.7 % to 86.2 % ) and the specificity was 100 % ( 95 % CI = 97.1 % to 100 % ) . The sensitivity for US was 98.1 % ( 95 % CI = 89.9 % to 99.9 % ) and the specificity was 99.2 % ( 95 % CI = 95.6 % to 99.9 % ) . The positive likelihood ratio for a PTX was 121 . Spearman 's rank correlation showed at rho of 0.82 . CONCLUSIONS With CT as the criterion st and ard , US is more sensitive than flat AP chest radiography in the diagnosis of traumatic PTX . Furthermore , US allowed sonologists to differentiate between small , medium , and large PTXs with good agreement with CT results Introduction Early detection of pneumothorax in multiple trauma patients is critically important . It can be argued that the efficacy of ultrasonography ( US ) for detection of pneumothorax is enhanced if it is performed and interpreted directly by the clinician in charge of the patients . The aim of this study was to assess the ability of emergency department clinicians to perform bedside US to detect and assess the size of the pneumothorax in patients with multiple trauma . Methods Over a 14 month period , patients with multiple trauma treated in the emergency department were enrolled in this prospect i ve study . Bedside US was performed by emergency department clinicians in charge of the patients . Portable supine chest radiography ( CXR ) and computed tomography ( CT ) were obtained within an interval of three hours . Using CT and chest drain as the gold st and ard , the diagnostic efficacy of US and CXR for the detection of pneumothorax , defined as rapidity and accuracy ( sensitivity , specificity , positive predictive value , negative predictive value ) , were compared . The size of the pneumothorax ( small , medium and large ) determined by US was also compared to that determined by CT . Results Of 135 patients ( injury severity score = 29.1 ± 12.4 ) included in the study , 83 received mechanical ventilation .  The time needed for diagnosis of pneumothorax was significantly shorter with US compared to CXR ( 2.3 ± 2.9 versus 19.9 ± 10.3 minutes , p < 0.001 ) . CT and chest drain confirmed 29 cases of pneumothorax ( 21.5 % ) . The diagnostic sensitivity , specificity , positive and negative predictive values and accuracy  for US and radiography were 86.2 % versus 27.6 % ( p < 0.001 ) , 97.2 % versus 100 % ( not significant ) , 89.3 % versus 100 % ( not significant ) , 96.3 % versus 83.5 % ( p = 0.002 ) , and 94.8 % versus 84.4 % ( p = 0.005 ) , respectively . US was highly consistent with CT in determining the size of pneumothorax ( Kappa = 0.669 , p < 0.001 ) . Conclusion Bedside clinician-performed US provides a reliable tool and has the advantages of being simple and rapid and having higher sensitivity and accuracy compared to chest radiography for the detection of pneumothorax in patients with multiple trauma OBJECTIVES Focused assessment of sonography in trauma ( FAST ) has been shown useful to detect clinical ly significant hemoperitoneum in adults , but not in children . The objectives were to determine test characteristics for clinical ly important intraperitoneal free fluid ( FF ) in pediatric blunt abdominal trauma ( BAT ) using computed tomography ( CT ) or surgery as criterion reference and , second , to determine the test characteristics of FAST to detect any amount of intraperitoneal FF as detected by CT . METHODS This was a prospect i ve observational study of consecutive children ( 0 - 17 years ) who required trauma team activation for BAT and received either CT or laparotomy between 2004 and 2007 . Experienced physicians performed and interpreted FAST . Clinical ly important FF was defined as moderate or greater amount of intraperitoneal FF per the radiologist CT report or surgery . RESULTS The study enrolled 431 patients , excluded 74 , and analyzed data on 357 . For the first objective , 23 patients had significant hemoperitoneum ( 22 on CT and one at surgery ) . Twelve of the 23 had true-positive FAST ( sensitivity = 52 % ; 95 % confidence interval [ CI ] = 31 % to 73 % ) . FAST was true negative in 321 of 334 ( specificity = 96 % ; 95 % CI = 93 % to 98 % ) . Twelve of 25 patients with positive FAST had 
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There was substantial heterogeneity across studies , and the reported accuracy of POCS strongly depended on the population and affected body area .
: In patients with suspected blunt thoracoabdominal trauma , positive POCS findings are helpful for guiding treatment decisions .
However , with regard to abdominal trauma , a negative POCS exam does not rule out injuries and must be verified by a reference test such as CT .
This is of particular importance in paediatric trauma , where the sensitivity of POCS is poor .
Based on a small number of studies in a mixed population , POCS may have a higher sensitivity in chest injuries .