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Pediatric abdominal trauma: evaluation by computed tomography
N M Kane1, J J Cronan, G S Dorfman
1Department of Diagnostic Radiology, Rhode Island Hospital, Brown University Program in Medicine, Providence 02902.
Insights
Computed tomography (CT) effectively evaluates pediatric blunt abdominal trauma in stable patients. This imaging technique reliably identifies injuries, often enabling conservative management and avoiding surgery.
Area of Science:
- Radiology
- Pediatric Surgery
- Emergency Medicine
Background:
- Blunt abdominal trauma in children requires careful evaluation.
- Immediate laparotomy is not always indicated.
- Computed tomography (CT) offers a non-invasive imaging option.
Purpose of the Study:
- To assess the utility of CT in evaluating pediatric blunt abdominal trauma.
- To determine the accuracy of CT in identifying injuries.
- To evaluate the impact of CT findings on patient management.
Main Methods:
- Retrospective review of medical records and CT scans.
- Analysis of 100 consecutive pediatric patients with blunt abdominal trauma.
- Categorization of CT findings as normal or abnormal.
Main Results:
- 73% of CT scans were normal.
- Abnormal findings included splenic fractures, hepatic lacerations, and renal contusions.
- Only 2% of patients with abnormal CT findings required surgery, with 98% managed conservatively.
Conclusions:
- CT is the preferred imaging modality for hemodynamically stable pediatric patients with blunt abdominal trauma.
- CT accurately delineates injury extent, guiding conservative treatment.
- CT facilitates conservative management, reducing the need for surgical intervention.
Abstract:
When indications for immediate laparotomy are not present, CT of the abdomen and pelvis can be used to evaluate pediatric blunt abdominal trauma. During 2-year period, the medical records and abdominal/pelvic CT scans of 100 consecutive pediatric patients who were evaluated for blunt abdominal trauma were retrospectively reviewed. The scans appeared normal for 73 children. Of these children, 30 had severe head injuries and a depressed sensorium. A total of 27 abdominal/pelvic CT scans were interpreted as abnormal. Findings included nine splenic fractures, six renal contusions, nine hepatic lacerations, one duodenal hematoma, one traumatic pancreatitis, four bony injuries, six miscellaneous abnormalities, and one intraperitoneal bleed. Only two of these 27 patients required abdominal surgery. The remaining 25 patients were treated conservatively based upon a stable clinical state and CT delineation of the extent of injury. No mortality resulted. CT is the radiographic examination of choice for hemodynamically stable pediatric patients with blunt abdominal trauma. CT provided a reliable adjunct examination technique when a physical examination could not be performed and a complete history could not be obtained. The extent of abdominal/pelvic injuries is well delineated and can often be followed by diagnostic imaging, usually allowing for conservative therapy.