Indications for computed tomography in children with blunt abdominal trauma
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G A Taylor1, M R Eichelberger, R O'Donnell
1Department of Radiology, Children's National Medical Center, Washington, D.C.
Insights
Clinical factors like gross hematuria, abdominal tenderness, and lap belt injury help identify children at high risk for intra-abdominal injury after blunt trauma. These indicators aid in risk stratification when computed tomography (CT) is unavailable.
Area of Science:
- Pediatric Traumatology
- Emergency Medicine
- Radiology
Background:
- Blunt trauma in children can lead to intra-abdominal injuries, necessitating accurate risk assessment for appropriate management.
- Clinical variables are crucial for stratifying pediatric patients into high- and low-risk categories for these injuries.
- Computed tomography (CT) is a key diagnostic tool, but its availability may be limited.
Purpose of the Study:
- To identify clinical variables that predict intra-abdominal injury in children following blunt trauma.
- To develop a risk stratification model for assigning children to high- and low-risk categories.
- To provide adjuncts for clinical judgment in triage, especially when CT is unavailable.
Main Methods:
- Prospective enrollment of 600 children examined with CT after blunt trauma.
- Analysis of complete data sets from 375 children using stepwise logistic regression.
- Identification of predictor variables associated with the presence of abdominal injury.
Main Results:
- 174 children had CT-detected abdominal injury, with 95 classified as significant.
- Predictors of higher injury risk included: >3 clinical indications (OR 4.60), gross hematuria (OR 5.80), lap belt injury (OR 12.2), assault/abuse (OR 5.08), abdominal tenderness (OR 2.73), and Trauma Score ≤12 (OR 2.27).
- Asymptomatic hematuria or neurologic impairment without abdominal findings did not correlate with abnormal CT findings.
Conclusions:
- Specific clinical variables effectively identify children at increased risk for intra-abdominal injury post-blunt trauma.
- These findings support clinical judgment in triage, particularly in resource-limited settings or when managing multiple injuries.
- The identified indicators can aid in optimizing the use of CT scans for pediatric blunt trauma patients.
Abstract:
This investigation was undertaken to identify clinical variables, alone or in combination, that could be used to assign children to high- and low-risk categories for intra-abdominal injury following blunt trauma. Six hundred consecutive children who were examined with computed tomography (CT) following blunt trauma were enrolled. Complete data sets were available on 375 children. Stepwise logistic regression was used to identify predictor variables for the presence of abdominal injury. There were 174 children with abdominal injury detected by CT. Of these, 95 were classified as having significant injury. Indicators associated with significantly higher risk of abdominal injury included the following: more than three clinical indications given (odds likelihood ratio [OLR] = 4.60, 95% confidence interval [95% Cl] = 2.29, 9.21, p less than 0.001); gross hematuria (OLR = 5.80, 95% Cl = 2.51, 13.4, p less than 0.001); lap belt injury (OLR = 12.2, 95% Cl = 2.22, 66.8, p less than 0.01); assault or abuse as the mechanism of injury (OLR = 5.08, 95% Cl = 1.07, 24.2, p less than 0.05); abdominal tenderness (OLR = 2.73, 95% Cl = 1.296, 5.82, p less than 0.01); and Trauma Score less than or equal to 12 (OLR = 2.27, 95% Cl = 1.006, 5.13, p less than 0.01). No child with asymptomatic hematuria (n = 56), regardless of grade or neurologic impairment in the absence of abdominal findings (n = 15), had an abnormal CT examination. These data are useful as an adjunct to clinical judgment in triage when the availability of CT equipment is limited or there are competing extra-abdominal injuries.