ARTICLE IN PRESS
When is it safe to forgo abdominal CT in blunt-injured children? Shannon N. Acker, MD,a Camille L. Stewart, MD,a Genie E. Roosevelt, MD,b David A. Partrick, MD,a Ernest E. Moore, MD,c and Denis D. Bensard, MD,a,c Aurora and Denver, CO
Introduction. CT is the standard modality to diagnose solid organ injury after blunt trauma; however, the associated radiation carries a risk of cancer. We hypothesized that there are patient-specific factors that can identify those children who require abdominal CT. Methods. We reviewed all children admitted to 2 pediatric trauma centers after blunt trauma with liver or spleen injury from January 2009 to December 2013. The low-risk group was defined as a Glasgow Coma Scale (GCS) of 15 with normal pediatric age-adjusted shock index (heart rate/systolic blood pressure; SIPA) on presentation, and injury attributable to a single, nonmotorized, blunt force to the abdomen. The at-risk group did not meet these criteria. Results. We identified 206 children with blunt liver or spleen injury, 101 of whom met the low-risk criteria. Among these 101 children who met the low-risk criteria, there were no deaths, no children required laparotomy, only 1 child required a packed red cell transfusion, and no children required discharge to a rehabilitation facility. Conclusion. Children who present to the emergency department after blunt abdominal trauma by a nonmotorized force with a normal GCS and SIPA are unlikely to have a solid organ injury that will require intervention. (Surgery 2015;j:j-j.) From the Department of Pediatric Surgery,a Children’s Hospital Colorado, University of Colorado School of Medicine, Aurora, and the Departments of Pediatric Emergency Medicineb and Surgery,c Denver Health Medical Center, Denver, CO
CT IS THE GOLD STANDARD to diagnose solid organ injury after blunt abdominal trauma and is used frequently in pediatric patients.1 Recent data have brought attention to the risks associated with radiation exposure, particularly in young children.2 In 2013, Miglioretti et al2 quantified the risk of developing a future malignancy based on a child’s age at the time of CT; among children under
When is it safe to forgo abdominal CT in blunt-injured children? Shannon N. Acker, MD,a Camille L. Stewart, MD,a Genie E. Roosevelt, MD,b David A. Partrick, MD,a Ernest E. Moore, MD,c and Denis D. Bensard, MD,a,c Aurora and Denver, CO
Introduction. CT is the standard modality to diagnose solid organ injury after blunt trauma; however, the associated radiation carries a risk of cancer. We hypothesized that there are patient-specific factors that can identify those children who require abdominal CT. Methods. We reviewed all children admitted to 2 pediatric trauma centers after blunt trauma with liver or spleen injury from January 2009 to December 2013. The low-risk group was defined as a Glasgow Coma Scale (GCS) of 15 with normal pediatric age-adjusted shock index (heart rate/systolic blood pressure; SIPA) on presentation, and injury attributable to a single, nonmotorized, blunt force to the abdomen. The at-risk group did not meet these criteria. Results. We identified 206 children with blunt liver or spleen injury, 101 of whom met the low-risk criteria. Among these 101 children who met the low-risk criteria, there were no deaths, no children required laparotomy, only 1 child required a packed red cell transfusion, and no children required discharge to a rehabilitation facility. Conclusion. Children who present to the emergency department after blunt abdominal trauma by a nonmotorized force with a normal GCS and SIPA are unlikely to have a solid organ injury that will require intervention. (Surgery 2015;j:j-j.) From the Department of Pediatric Surgery,a Children’s Hospital Colorado, University of Colorado School of Medicine, Aurora, and the Departments of Pediatric Emergency Medicineb and Surgery,c Denver Health Medical Center, Denver, CO
CT IS THE GOLD STANDARD to diagnose solid organ injury after blunt abdominal trauma and is used frequently in pediatric patients.1 Recent data have brought attention to the risks associated with radiation exposure, particularly in young children.2 In 2013, Miglioretti et al2 quantified the risk of developing a future malignancy based on a child’s age at the time of CT; among children under
