Abstract
IntroductionChildren with blunt abdominal trauma (BAT) are often hospitalized despite no intervention. We identified factors associated with emergency department (ED) disposition of children with BAT and differing computed tomography (CT) findings.Methods:We surveyed pediatric and general emergency physicians (EPs), pediatric and trauma surgeons regarding care of 2 hypothetical asymptomatic patients: a 9-year-old struck by a slow-moving car (Case 1) and an 11-month-old who fell 10 feet (Case 2). We presented various abdominal CT findings and asked physicians about disposition preferences. We evaluated predictors of patient discharge using multivariable regression analysis, adjusting for hospital and ED characteristics, and clinician experience. Pediatric EPs served as the reference group.Results:Of 2,003 eligible surveyed, 636 (32%) responded. For normal CTs, 99% would discharge in Case 1 and 88% in Case 2. Prominent specialty differences included: for trace intraperitoneal fluid (TIF), 68% would discharge in Case 1 and 57% in Case 2. Patients with TIF were less likely to be discharged by pediatric surgeons (Case 1: OR 0.52, 95% CI 0.32, 0.82; Case 2: OR 0.49, 95% CI 0.30, 0.79). Patients with renal contusions were less likely to be discharged by pediatric surgeons (Case 1: OR 0.55, 95% CI 0.32, 0.95) and more likely by general EPs (Case 1: OR 1.83, 95% CI 1.25, 2.69; Case 2: OR 2.37, 95% CI 1.14, 4.89).Conclusion:Substantial variation exists between specialties in reported hospitalization practices of asymptomatic children after abdominal trauma with minor CT findings. Better evidence is needed to guide disposition decisions.
Highlights
Children with blunt abdominal trauma (BAT) are often hospitalized despite no intervention
Patients with trace intraperitoneal fluid (TIF) were less likely to be discharged by pediatric surgeons (Case 1: odds ratios (OR) 0.52, 95% confidence intervals (CI) 0.32, 0.82; Case 2: OR 0.49, 95% CI 0.30, 0.79)
Patients with renal contusions were less likely to be discharged by pediatric surgeons (Case 1: OR 0.55, 95% CI 0.32, 0.95) and more likely by general emergency physicians (EPs) (Case 1: OR 1.83, 95% CI 1.25, 2.69; Case 2: OR 2.37, 95% CI 1.14, 4.89)
Summary
Children with blunt abdominal trauma (BAT) are often hospitalized despite no intervention. We identified factors associated with emergency department (ED) disposition of children with BAT and differing computed tomography (CT) findings. More than 600,000 children with blunt abdominal trauma are evaluated annually in United States (U.S.) emergency departments (EDs), many of whom undergo abdominal imaging. IAIs are identified in fewer than 20% of children imaged after blunt abdominal trauma.[3]. Controversy remains regarding disposition of the child after blunt traumatic injury. It remains unclear whether hospitalization is necessary when a minor IAI has been identified, as relatively few patients with IAIs require acute, specific therapy.[4,5] The great majority of children with solid organ injuries are managed non-operatively.
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