CT scan in the evaluation of pediatric abdominal trauma

Abstract

Objective: to assess the need of computed tomography (CT) for the definition of management in pediatric abdominal trauma. Methods: observational retrospective study with patients under 18 years old victims of blunt or penetrating abdominal trauma that underwent CT of the abdomen and pelvis at admission. We evaluated CT scan findings, indications and management. We calculated the sensitivity, specificity, positive predictive value and negative predictive value of clinical variables and energy of trauma for findings on CT. Results: among the 236 patients included in our study, 72% (n=170) did not present abnormal findings on CT. It was performed surgical treatment in 15% (n=10), conservative treatment in 54,5% (n=36) and 27% (n=18) did not receive treatment for abdominal injuries. In the assessment of CT indications, 28,8% (n=68) presented no justifications. In this group, 91% (n=62) did not show any abnormal findings. Among the six patients with positive findings, half were selected for conservative treatment, while the rest did not need any treatment for abdominal injuries. The presence of abdominal pain, hemodynamic alterations and high energy blunt trauma had low positive predictive values when isolated, whereas the negative predictive values were higher. Conclusion: although CT is necessary in some instances, there is a possible high number of exams that did not make any difference in the management of the pediatric population.

Uncommon presentation: isolated small bowel perforation after blunt abdominal trauma in a pediatric patient; a case report

“…However, a study done in South Korea also reports that delay in surgical intervention following BAT may not affect the outcomes of patients with small bowel injury with regard to length of stay, ICU stays, morbidity, and mortality except for bowel resection 8 . Due to its high sensitivity, CT is considered the gold standard for the evaluation of suspected intra-abdominal injuries after blunt trauma in adults but doses of ionizing radiation brought by CT can damage DNA, increasing the risk of cancer throughout life and should be kept in consideration while ordering CT in children 9 . A study in Brazil concluded that although CT is necessary in some instances, there is a possible high number of exams that did not make any difference in the management of the pediatric population 9 .…”

“…Due to its high sensitivity, CT is considered the gold standard for the evaluation of suspected intra-abdominal injuries after blunt trauma in adults but doses of ionizing radiation brought by CT can damage DNA, increasing the risk of cancer throughout life and should be kept in consideration while ordering CT in children 9 . A study in Brazil concluded that although CT is necessary in some instances, there is a possible high number of exams that did not make any difference in the management of the pediatric population 9 . The FAST examination has also been associated with improvements in outcomes among adult patients including reductions in abdominal computed tomographic (CT) rates, decreased time to the operating room, and decreased hospital length of stay 10 .…”