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Three Part Question

In [a child with a soft tissue foreign body], is [ultrasound better than xray] at [detection of the foreign body]?

Clinical Scenario

A 6-year-old girl presents to the emergency department with complaints of a painful foot, and the history of having stepped on an unknown foreign body. You wonder whether an x-ray or ultrasound would be better at detecting this.

Search Strategy

Medline 1950-02/07
SOFT ADJ TISSUE AND FOREIGN ADJ BODY AND ULTRASOUND AND (CHILD# OR ADOLESCENT.DE. OR INFANT#) AND LG=EN

Search Outcome

22 papers were found, of which 21 were irrelevant or of insufficient quality. The remaining paper is shown in the table below.

Relevant Paper(s)

Author, date and country	Patient group	Study type (level of evidence)	Outcomes	Key results	Study Weaknesses
Friedman D et al 2004 US	105 children with a suspected retained FB	Prospective diagnostic cohort	Foreign body detected and recovered	12 foreign bodies identified.	12 foreign bodies identified. US detected 8 of 12, and x-ray 7 of 12 cases.

Comment(s)

Bedside US technique and interpretation has potential limitations with differences in US expertise among physicians.

Clinical Bottom Line

Bedside US is comparable to radiography, and may be an ideal ED screening tool in the detection of soft tissue FBs in children.

References

1. Friedman DI, Forti RJ, Wall SP, Crain EF. The Utility of Bedside Ultrasound and Patient Perception in Detecting Soft Tissue Foreign Bodies in Children. Paediatric Emergency Care 2005;21(8)