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Costal Margin Tenderness and the Risk for Intraabdominal Injuries in Children With Blunt Abdominal Trauma

Katherine T Flynn-O'Brien1, Nathan Kuppermann2,3, James F Holmes2,3

  • 1Department of Surgery, University of Washington, Seattle, WA.

Academic Emergency Medicine : Official Journal of the Society for Academic Emergency Medicine
|April 15, 2018
PubMed

Insights

Costal margin tenderness (CMT) in children with blunt torso trauma is not a reliable indicator of intra-abdominal injuries (IAI). Isolated CMT in children has a minimal risk of IAI, suggesting CT scans may be of low yield.

Area of Science:

  • Pediatric Emergency Medicine
  • Diagnostic Imaging
  • Trauma Surgery

Background:

  • Radiation exposure from CT scans in children is a known concern.
  • Physician decisions for CT imaging in pediatric blunt torso trauma are influenced by patient history and physical exam findings, such as costal margin tenderness (CMT).

Purpose of the Study:

  • To evaluate the significance of CMT in identifying children with intra-abdominal injuries (IAI) on CT scans.
  • To assess the utility of CMT for identifying children with IAI requiring acute intervention.

Main Methods:

  • Analysis of the Pediatric Emergency Care Applied Research Network (PECARN) IAI prospective multicenter cohort data (May 2007-January 2010).
  • Defined isolated CMT as tenderness without other PECARN risk factors for IAI.
  • Used logistic regression to calculate adjusted odds of IAI and risk differences for CMT, and estimated CT utilization.

Main Results:

  • Among 9,174 children with blunt torso trauma, 13.8% had CMT.
  • No children (0%) with isolated CMT had IAI, compared to 17.2% with non-isolated CMT.
  • 20.3% of children with isolated CMT underwent abdominal CT scans.

Conclusions:

  • Isolated CMT in children with blunt torso trauma is associated with a minimal risk of intra-abdominal injuries.
  • Abdominal CT scans in children with blunt abdominal trauma and isolated CMT appear to be of low diagnostic yield.
Abstract

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