Mechanism of injury alone is not justified as the sole indication for computed tomographic imaging in blunt pediatric trauma

Moore, Hunter B.; Faulk, Leonard W.; Moore, Ernest E.; Pierraci, Fredric; Burlew, Clay Cothren; Holscher, Courtenay M.; Barnett, Carlton C.; Jurkovich, Gregory J.; Bensard, Denis D.

doi:10.1097/ta.0b013e3182ab065b

Cited by 28 publications

(8 citation statements)

References 25 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…We have previously shown that mechanism in and of itself should not direct CT imaging in trauma. 7 We have also shown that an elevated shock index pediatric age adjusted on presentation to the emergency department can accurately identify severely injured children. 6 Our current results suggest that combining SIPA with mechanism of injury can be used to guide decision making in an effort to reduce unnecessary CT imaging of children.…”

Section: Discussionmentioning

confidence: 96%

When is it safe to forgo abdominal CT in blunt-injured children?

Acker

Stewart

Roosevelt

et al. 2015

Surgery

Self Cite

View full text Add to dashboard Cite

Section: Discussionmentioning

confidence: 96%

When is it safe to forgo abdominal CT in blunt-injured children?

Acker

Stewart

Roosevelt

et al. 2015

Surgery

Self Cite

View full text Add to dashboard Cite

“…Hemodynamically stable patients with an abnormal physical examination, patients with altered levels of consciousness and patients whose mechanism of injury suspicious for internal organ injury undergo further evaluation with CT [ 7 ]. However, in the pediatric population, recent studies have shown that using CT scan, based solely on the mechanism of injury, is not justified [ 3 , 4 ].…”

Section: Discussionmentioning

confidence: 99%

“…While in the management of a stable adult patient with blunt abdominal trauma the indications for a CT scan are established [ 2 ], its use in the pediatric population is still a matter of debate. It has been shown that the mechanism of injury as a sole indication for obtaining a CT scan in pediatric trauma victims does not clearly predict significant findings affecting patient management [ 3 , 4 ].…”

Section: Introductionmentioning

confidence: 99%

Elevated white blood cell count, decreased hematocrit and presence of macrohematuria correlate with abdominal organ injury in pediatric blunt trauma patients: a retrospective study

et al. 2015

View full text Add to dashboard Cite

IntroductionComputerized tomography (CT) has become an important diagnostic modality in trauma patients. Pediatric patients are particularly susceptible to ionized radiation making liberal CT use in this age group unacceptable. We aimed to identify parameters that might predict abnormal findings on abdominal CT leading to patient management changes.MethodsData on blunt trauma patients up to 15 years of age admitted to Assaf Harofeh Medical Center from January 2007 to October 2014 was retrospectively collected. All patients with abdominal CT scan as part of initial assessment were included. Medical and surgical data were extracted from the medial charts. Patients were divided into two groups. Group I: patients whose management was changed solely based on abdominal CT findings and Group II: patients with normal abdominal CT. The groups were compared by all the data parameters.ResultsOverall, 182 patients were included in the study. The groups were comparable by age and mechanism of injury. Management changes based on CT findings were found in 68 (37.4 %) patients. White blood cell count >14000, abnormally low hematocrit level and macrohematuria were associated with a diagnosis of intra-abdominal injury requiring patient management changes (p < 0.05). Group I patients had longer LOS. Fifteen patients (22 %) required active intervention based solely on CT findings. Physical examination, arterial blood gases and initial radiology examinations results did not correlate with abdominal CT findings.ConclusionsElevated WBC, decreased hematocrit and presence of macrohematuria strongly correlate with abdominal CT findings and lead to changes in patient management.

show abstract

“…Moore et al found that in children, CT imaging only based on mechanism of injury did not detect any serious positive findings. Therefore, the use of CT imaging in injured children in the absence of a physiologic or anatomic abnormality does not seem to be justified [29]. Auner und Marzi recommend that in children who are alert and assessable without clinical abnormalities and normal sonographic and radiographic findings a CT imaging is not necessary [3].…”

Section: Diagnostic Value Of Computed Tomographymentioning

confidence: 99%

Pediatric trauma care with computed tomography—criteria for CT scanning

et al. 2015

View full text Add to dashboard Cite

Trauma centers, trauma management concepts, as well as integration of whole-body computed tomography (CT) reduced mortality significantly. The accuracy of a trauma care algorithm with emergency CT in children was evaluated. Data of 71 children with emergency CT were recorded retrospectively. In addition to epidemiological data admission date, kind of CT scan, mechanism of injury, missed diagnoses, injury severity score (ISS), admission to and time on intensive care unit (ICU), and time of hospitalization were observed. The algorithm for CT scanning was based on mechanism of injury, pattern of injury, and altered vital signs. Sixty-nine percent of the children reached the ER during on-call service hours. A percentage of 32.4 received a whole-body scan and 67.6 % a cranial scan. The mean ER ISS was 9.9 points (1-57). Children have different trauma mechanisms compared to adults. A percentage of 33.8 of the children had relevant trauma related findings in the CT scan. In 2 children, (2.8 %) 3 diagnoses (2.2 %) were initially missed. After reevaluation of the CT data, all diagnoses were identified. Thus, the accuracy of our algorithm in children was 100 %. In children, our algorithm detected all injuries, but only one third of the children had relevant trauma related findings in the CT scan. In order to reduce radiation exposure but preserve the advantages of CT, a new algorithm was developed with more flexibility taking the child's age and mental status more into account as well as clinical findings. The mechanism of injury itself is not anymore an indication for CT scanning.

show abstract

Mechanism of injury alone is not justified as the sole indication for computed tomographic imaging in blunt pediatric trauma

Abstract: Care management study, level IV.

Cited by 28 publications

References 25 publications

When is it safe to forgo abdominal CT in blunt-injured children?

When is it safe to forgo abdominal CT in blunt-injured children?

Elevated white blood cell count, decreased hematocrit and presence of macrohematuria correlate with abdominal organ injury in pediatric blunt trauma patients: a retrospective study

Pediatric trauma care with computed tomography—criteria for CT scanning

Contact Info

Product

Resources

About