Emergency Department Observation and Computed Tomography Use in Children With Blunt Abdominal Trauma

We evaluated the association of observation with computed tomography (CT) use in children with blunt abdominal trauma.

We performed a secondary analysis of a prospective multicenter cohort study of children with blunt abdominal trauma. Clinicians documented Pediatric Emergency Care Applied Research Network abdominal trauma rule variables and whether a period of observation with deferred CT decisionmaking was performed. Intra-abdominal injury undergoing acute intervention was defined as intra-abdominal injury resulting in surgery, angiography, blood transfusion, or death. We used multivariable logistic regression to examine the association between observation status and CT use, adjusting for age, study site, clinician suspicion of intra-abdominal injury, and Pediatric Emergency Care Applied Research Network predicition rule variables.

Among 7,442 children with documented observation status, 2,024 (27.2%, 95% confidence interval [CI] 26.2%, 28.2%) underwent observation. CT use was less frequent among observed patients (414/2,024 [20.5%]) than those not observed (2,011/5,418 [37.1%; difference 16.7%, 95% CI 14.5%, 18.8%]). Intra-abdominal injury undergoing acute intervention occurred in 8/2,024 (0.4%) of observed versus 137/5,418 (2.5%) of not observed patients (difference 2.1%, 95% CI 1.6%, 2.6%). Observation was associated with lower CT use when clinician suspicion of intra-abdominal injury was 1% to 5% (odds ratio [OR] = 0.31, 95% CI 0.25, 0.39), 6% to 10% (OR = 0.15, 95% CI 0.10, 0.23), and 11% to 50% (OR = 0.18, 95% CI 0.08%, 0.39%). A total of 1,610 (79.5%) observed patients were discharged without CT, and none (0%, 95% CI 0%, 0.3%) had intra-abdominal injury undergoing acute intervention.

Observation with deferred CT decisionmaking was associated with less frequent CT use, particularly in patients with intermediate clinician suspicion, without an increase in missed injuries.