SummaryIntroductionThe diagnostic accuracy of gastric ultrasound in children has not been assessed thoroughly. We aimed to determine the sensitivity and specificity in children of a qualitative ultrasound examination of the gastric antrum in the supine 45° semi‐recumbent position and a clinical algorithm for detecting a gastric fluid volume > 1.25 ml.kg‐1, reported to represent an ‘at‐risk stomach’ for pulmonary aspiration.MethodsWe conducted a prospective, observer‐blinded, randomised trial in healthy children fasted according to current pre‐operative guidelines. An initial ultrasound assessment of gastric contents ensured that the stomach was empty. Children then drank a specific volume of water (0; 0.6; 1; 1.25; 1.5; or 2 ml.kg‐1). Gastric ultrasound was performed after 3 min of fluid ingestion, in children lying supine and then in the right lateral decubitus position, with the head of the bed elevated to 45° (semi‐recumbent). A clinical algorithm combining the qualitative assessment with calculation of gastric fluid volume was also completed. The sensitivity and specificity of the qualitative assessment in the supine semi‐recumbent position and the clinical algorithm for the diagnosis of gastric fluid volume > 1.25 ml.kg‐1 were estimated.ResultsNinety children, median (IQR [range]) age 7 (4.5–9 [1–10]) y, were studied. The sensitivity and specificity of the qualitative assessment for detecting gastric fluid volume > 1.25 ml.kg‐1 were 75% (95%CI 58–88%) and 85% (95%CI 73–93%), respectively. The sensitivity and specificity of the clinical algorithm were 86% (95%CI 71–95%) and 78% (95%CI 64–88%), respectively.DiscussionIn order to achieve high sensitivity of gastric ultrasound for the diagnosis of fluid volume > 1.25 ml.kg‐1 in children, qualitative ultrasound assessment of gastric antrum contents should be combined with calculation of gastric fluid volume when fluid contents are seen in the gastric antrum.

中文翻译：

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定性胃超声评估检测儿童高胃液量的诊断准确性：一项前瞻性随机研究


摘要引言儿童胃超声的诊断准确性尚未得到彻底评估。我们旨在确定在仰卧位 45° 半卧位对胃窦进行定性超声检查的儿童敏感性和特异性，以及检测胃液量 > 1.25 ml.kg-1 的临床算法，据报道代表肺误吸的“高危胃”。方法我们根据当前的术前指南对禁食的健康儿童进行了一项前瞻性、观察者盲法、随机试验。对胃内容物的初步超声评估确保胃是空的。然后，儿童饮用特定体积的水（0、0.6、1、1.25、1.5 或 2 ml.kg-1）。摄入液体 3 分钟后，对仰卧位和右侧卧位的儿童进行胃超声检查，床头抬高至 45°（半卧位）。还完成了将定性评估与胃液量计算相结合的临床算法。估计仰卧半卧位定性评估的敏感性和特异性以及诊断胃液量 > 1.25 ml.kg-1 的临床流程。结果研究了 90 名儿童，中位 （IQR [范围]） 7 岁 （4.5-9 [1-10]） y。检测胃液体积 > 1.25 ml.kg-1 的定性评估的敏感性和特异性分别为 75% （95% CI 58-88%） 和 85% （95% CI 73-93%）。临床算法的敏感性和特异性分别为 86% （95% CI 71-95%） 和 78% （95% CI 64-88%）。讨论为了实现胃超声诊断液体体积 > 1.25 ml 的高灵敏度。kg-1 在儿童中，当在胃窦中观察到液体内容物时，应将胃窦内容物的定性超声评估与胃液量的计算相结合。