Abstract
IntroductionComputerized tomography (CT) has become an important diagnostic modality in trauma patients. Pediatric patients are particularly susceptible to ionized radiation making liberal CT use in this age group unacceptable. We aimed to identify parameters that might predict abnormal findings on abdominal CT leading to patient management changes.MethodsData on blunt trauma patients up to 15 years of age admitted to Assaf Harofeh Medical Center from January 2007 to October 2014 was retrospectively collected. All patients with abdominal CT scan as part of initial assessment were included. Medical and surgical data were extracted from the medial charts. Patients were divided into two groups. Group I: patients whose management was changed solely based on abdominal CT findings and Group II: patients with normal abdominal CT. The groups were compared by all the data parameters.ResultsOverall, 182 patients were included in the study. The groups were comparable by age and mechanism of injury. Management changes based on CT findings were found in 68 (37.4 %) patients. White blood cell count >14000, abnormally low hematocrit level and macrohematuria were associated with a diagnosis of intra-abdominal injury requiring patient management changes (p < 0.05). Group I patients had longer LOS. Fifteen patients (22 %) required active intervention based solely on CT findings. Physical examination, arterial blood gases and initial radiology examinations results did not correlate with abdominal CT findings.ConclusionsElevated WBC, decreased hematocrit and presence of macrohematuria strongly correlate with abdominal CT findings and lead to changes in patient management.
Highlights
Computerized tomography (CT) has become an important diagnostic modality in trauma patients
Overall, 397 pediatric patients with abdominal trauma were admitted to our Medical Center during the study period
There was no difference in the patient characteristics between the two groups, with the exception of the Injury Severity Score (ISS) which was higher in Group I
Summary
Computerized tomography (CT) has become an important diagnostic modality in trauma patients. The potential risk of radiation damage caused by CT scan dictates careful use of this imaging modality [1]. While in the management of a stable adult patient with blunt abdominal trauma the indications for a CT scan are established [2], its use in the pediatric population is still a matter of debate. It has been shown that the mechanism of injury as a sole indication for obtaining a CT scan in pediatric. The indications for abdominal imaging after blunt trauma are usually based on physical examination and mechanism of injury suggestive of intra-abdominal injury [5]. Abdominal CT is considered the best imaging modality for diagnosing intra-abdominal injury (IAI), less than 15 % of pediatric patients sustaining blunt trauma are found to have IAI on CT [5].
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