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CT scans could be avoided for children’s abdominal injuries
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Recent study findings may enable clinicians to determine which children do not require exposure to computed tomography scans after blunt trauma to the abdomen.
The prospective study by James F. Holmes, MD, MPH, professor of emergency medicine at UC Davis School of Medicine in Sacramento, Calif., and colleagues involved 12,044 children who arrived at EDs in the Pediatric Emergency Care Applied Research Network after blunt trauma to their torsos from May 2007 to January 2010.
James F. Holmes
Researchers identified seven factors that can help physicians determine the need for a CT scan after trauma. They include: 1) evidence of abdominal wall trauma or seat belt sign; 2) Glasgow Coma Scale score ≤14; 3) abdominal tenderness; 4) evidence of thoracic wall trauma; 5) complaints of abdominal pain; 6) increased breath sounds; 6) and vomiting.
Children without any of the factors when evaluated in the ED had only a 0.1% chance of having an abdominal injury that required acute intervention. Therefore, a CT scan for most patients would not likely provide useful information, the researchers concluded.
Abdominal CT scans were obtained for 5,514 (46%) patients, including 5,380 in the ED, 232 during hospitalizations and 55 after discharge from the ED. Researchers said 761 patients were diagnosed with intra-abdominal injuries, including 204 with injuries to more than one organ.
Nearly one-quarter (23%) of the abdominal CT scans performed were obtained in the very-low-risk patients. Researchers said this suggests there is substantial potential for reduction of unnecessary abdominal CT scans in children after blunt torso trauma because the purpose of the current prediction rule was to identify low-risk children in whom CT could be prevented. However, they said, the rule is not intended to suggest that all of those who screen positive for one or more rule variable must undergo abdominal CT scanning.
“CT scans involve significant radiation risk, especially for children, who are more vulnerable than adults to radiation's effects,” Holmes said in a press release. “We have now identified a population of pediatric patients that does not typically benefit from a CT scan, which is an important step in reducing radiation exposure.”
Researchers said the findings of the study require external validation before implementation.
Disclosure: The researchers report no relevant financial disclosures.
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