Analytical revisit to basics helps reduce unnecessary CT scan in children with abdominal trauma: A single institution experience

Abstract

Introduction. CT scan is regarded as the investigation choice for accurate depiction of blunt abdominal injuries in children and is considered as an inevitable tool in the armamentarium of the clinician before deciding for conservative management of these children. However over dependence on CT scan puts the patient to many disadvantages.
 The aim of this study to devise stratification criteria for the children with blunt abdominal injury and advise CT scan to the children only who really require it.
 Material and methods. All the children with blunt abdominal injury were studied prospectively over a period of two years. These children underwent clinical, biochemical and ultrasonographic assessment at presentation followed by CT abdomen. Efficacy of predefined clinical, biochemical and ultrasonographic parameters was compared with CT scan to triage the children with intra abdominal injury.
 Results. A total of 84 children were registered in the study based on final diagnosis of presence or absence of intra abdominal injury the children were divided in two groups. These groups were then compared for various clinical, laboratory and ultrasonographic parameters to predict intra abdominal injury. The children having isolated abdominal injury, tenderness, raised AST, ALT and amylase and free fluid on ultrasonography were found to have more chances of intrabdominal injury (p < 0.001). These parameters were the most sensitive parameters to predict intra abdominal injury and the cumulative sensitivity of these parameters was 99.7%. The CT abdomen was negative in 74.7% of the patients.
 Conclusion. Due to high negative rate of CT abdomen in children with abdominal trauma, its use as first line imaging investigation is questionable in all the children with abdominal trauma. We suggest that by utilizing clinical, biochemical and ultrasonographic parameters, the children at risk of intra abdominal injuries can identified with almost 100% accuracy mandating the use of CT scan only in these children.

Clinical and biochemical parameters for the selective use of chest computed tomography in pediatric blunt trauma patients

“…In the study of Stephens et al, there was no change in chest CT utilization rates despite the pressures in reducing the use of chest CT at the initial examination of pediatric trauma patients [25]. For this reason, new markers should be determined separately from the chest radiograph in order to determine the patients who will benefit from chest CT. Khan et al, suggest that by utilizing clinical, biochemical and ultrasonographic parameters, almost ¾ th of the children with abdominal trauma could be avoided from unnecessary radiation by reducing the CT scan rate [26]. For this purpose, we investigated the predictive role of clinical and biochemical parameters whether chest CT rate could be decreased in high energy blunt thoracic trauma in children.…”

Accuracy of FAST (Focused Abdominal Sonography in Trauma) scan in diagnosis of significant abdominal trauma using CT abdomen as gold standard.

“…Seventy-five percent patients of BAT are associated with the motor vehicle collision. 6,7 Abdomen blows and falls are accountable for 15.0% and 6.0% to 9.0% patients respectively. 8 BAT due to occult BAT may happen in a result of child abuse and violence in domestic activities.…”