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CT scan in the evaluation of pediatric abdominal trauma
Isabella Perin1, Camila Roginski Guetter1,2, Lúcio Eduardo Klüppel3
1- Universidade Federal do Paraná - Curitiba - PR - Brasil.
Insights
Computed tomography (CT) scans for pediatric abdominal trauma often reveal no injuries, suggesting overuse. Clinical factors alone have limited predictive value, highlighting the need to refine CT indications in this population.
Area of Science:
- Medical Imaging
- Pediatric Surgery
- Emergency Medicine
Background:
- Pediatric abdominal trauma management relies on accurate diagnostic tools.
- Computed tomography (CT) is frequently used but its necessity requires evaluation.
Purpose of the Study:
- To assess the utility of CT scans in guiding management decisions for pediatric abdominal trauma.
- To determine if CT scans are always necessary for defining treatment in these cases.
Main Methods:
- An observational retrospective study of 236 pediatric patients (<18 years) with abdominal trauma.
- Evaluation of CT findings, indications, and subsequent management.
- Calculation of diagnostic values for clinical variables and trauma energy.
Main Results:
- 72% of patients had no CT-detected abnormalities.
- 28.8% of CT scans lacked clear justifications, with 91% of these showing no findings.
- Clinical factors like pain and hemodynamic instability had low positive predictive values.
Conclusions:
- CT scans are essential in select pediatric abdominal trauma cases.
- A significant number of CT examinations do not alter patient management, indicating potential overuse.
Objective:
to assess the need of computed tomography (CT) for the definition of management in pediatric abdominal trauma.
Methods:
observational retrospective study with patients under 18 years old victims of blunt or penetrating abdominal trauma that underwent CT of the abdomen and pelvis at admission. We evaluated CT scan findings, indications and management. We calculated the sensitivity, specificity, positive predictive value and negative predictive value of clinical variables and energy of trauma for findings on CT.
Results:
among the 236 patients included in our study, 72% (n=170) did not present abnormal findings on CT. It was performed surgical treatment in 15% (n=10), conservative treatment in 54,5% (n=36) and 27% (n=18) did not receive treatment for abdominal injuries. In the assessment of CT indications, 28,8% (n=68) presented no justifications. In this group, 91% (n=62) did not show any abnormal findings. Among the six patients with positive findings, half were selected for conservative treatment, while the rest did not need any treatment for abdominal injuries. The presence of abdominal pain, hemodynamic alterations and high energy blunt trauma had low positive predictive values when isolated, whereas the negative predictive values were higher.
Conclusion:
although CT is necessary in some instances, there is a possible high number of exams that did not make any difference in the management of the pediatric population.
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