Reasons for performing abdominal computed tomography in pediatric emergency departments providing trauma care: a...

OBJECTIVE: This study aimed to evaluate the indications for abdominal computed tomography (CT) in children aged 0–18 years presenting to the Pediatric Emergency Department. Associated factors, the use of alternative imaging modalities, diagnostic outcomes, and the need for surgical intervention were also assessed. METHODS: Children aged 0–18 years who presented between January 2018 and December 2022 and underwent abdominal CT, as determined by a pediatrician or pediatric emergency physician, were included. RESULTS: A total of 562 patients were analyzed (mean age: 142 months; 55% male). In traumatic cases, the most common indications for CT were abdominal tenderness, unreliable physical examination, and hemodynamic instability, whereas abdominal pain, tenderness, and vomiting predominated in non-traumatic cases. Ultrasonography (US) was used more frequently in non-traumatic patients, while direct CT without prior US was more common in trauma patients (p < 0.01). CT contributed to diagnosis but not to surgical decision-making in traumatic patients, whereas it significantly contributed to both diagnosis and surgical decision-making in non-traumatic patients. When US findings were normal, CT most commonly identified liver and splenic lacerations in traumatic patients and acute appendicitis in non-traumatic patients. In the presence of normal US findings, pathology detected on CT was strongly associated with surgical intervention (OR = 22, p < 0.001). CONCLUSIONS : Despite the relatively high use of CT in pediatric trauma, most examinations yielded normal findings. Clinical examination and laboratory results should guide imaging decisions rather than reliance on trauma mechanism alone. A selective, clinically driven approach to CT utilization is essential in pediatric abdominal conditions, particularly in non-traumatic patients and in cases with inconclusive ultrasonographic findings.