Is Hospital Admission and Observation Required after a Normal Abdominal Computed Tomography Scan in Children with Blunt Abdominal Trauma?

Abstract

Objectives: The objective was to determine if hospital admission of children with blunt abdominal trauma for observation of possible intraabdominal injury (IAI) is necessary after a normal abdominal computed tomography (CT) scan in the emergency department (ED). Methods:The authors conducted a prospective observational cohort study of children less than 18 years of age with blunt abdominal trauma who underwent an abdominal CT scan in the ED. Abdominal CT scans were obtained with intravenous contrast but no oral contrast. The decision to hospitalize the patient was made by the attending emergency physician (EP) with the trauma or pediatric surgery teams. An abnormal abdominal CT scan was defined by the presence of any visualized IAI or findings suggestive of possible IAI (e.g., intraperitoneal fluid without solid organ injury). Patients were followed to determine if IAI was later diagnosed and the need for acute therapeutic intervention if IAI was present.Results: A total of 1,295 patients underwent abdominal CT, and 1,085 (84%) patients had normal abdominal CT scans in the ED and make up the study population. Seven-hundred thirty-seven (68%) were hospitalized, and 348 were discharged to home. None of the 348 patients discharged home and 2 of the 737 hospitalized patients were identified with an IAI after a normal initial abdominal CT. The IAIs in patients with normal initial CT scans included a 10-year-old with a mesenteric hematoma and serosal tear at laparotomy and a 10-year-old with a perinephric hematoma on repeat CT. Neither underwent specific therapy. The negative predictive value (NPV) of a normal abdominal CT scan for IAI was 99.8% (95% confidence interval [CI] = 99.3% to 100%). Conclusions:Children with blunt abdominal trauma and a normal abdominal CT scan in the ED are at very low risk of having a subsequently diagnosed IAI and are very unlikely to require a therapeutic intervention. Hospitalization of children for evaluation of possible undiagnosed IAI after a normal abdominal CT scan has a low yield and is generally unnecessary.ACADEMIC EMERGENCY MEDICINE 2008; 15:895-899 ª

Comparison of Clinician Suspicion Versus a Clinical Prediction Rule in Identifying Children at Risk for Intra‐abdominal Injuries After Blunt Torso Trauma

“…19 Consistent with prior studies, the parent study of the current analysis 18 revealed the prevalence rate of intra-abdominal injury undergoing acute intervention to be less than 2% of children with blunt torso trauma, while nearly half of the children presenting with blunt torso trauma underwent abdominal CT scaning. 15,[20][21][22] In both adult and pediatric trauma patients, CT use has rapidly increased in the ED for many conditions. Indiscriminate use of CT is not without risks as it leads to increased health care costs, increased risk of contrastinduced nephropathy, and most importantly, increased risk of radiation-induced malignancies.…”

Variation in Specialists' Reported Hospitalization Practices of Children Sustaining Blunt Abdominal Trauma

“…In both hypothetical cases, almost all physicians surveyed were willing to discharge patients given normal abdominal CTs. While abdominal CT is not perfectly sensitive for IAI, particularly pancreatic injuries, such injuries are unlikely in patients with normal CTs, normal mental status, and non-tender abdominal examinations 3, 9–12. In a meta-analysis of nearly 2,600 pediatric blunt trauma patients, the prevalence of IAI after a normal abdominal CT was 0.19% and the negative predictive value of a normal abdominal CT was 99.8% 13…”

Will computed tomography (CT) miss something? The characteristics and pitfalls of torso CT in evaluating patients with blunt solid organ trauma

“…Spleen (111) Kidney (69) Others (6) Liver (6) Spleen (6) Kidney ( Others (22) Bowel and mesentery (6) Diaphragm (2) Gall bladder (1) Urinary bladder (1) Inferior vena cava (1) Liver (4) Kidney (3) Pancreas (1) Atrium (1) Liver ( have suggested that a blunt trauma patient could be discharged safely after a negative CT examination. [3,4] However, another study compared the results of CT and autopsy in 113 trauma patients and found that CT had a high rate of missed diagnoses of abdominal organ injuries. [5] In addition, CT has proven to be less useful in detecting hollow viscus injuries.…”