Pediatric Abdominal Trauma Imaging

Carlos J. Sivit, MD

Disclosures

Appl Radiol. 2013;42(5):8-13. 

In This Article

Impact of CT on Medical Decision Making

The role of CT in evaluating injured children includes establishing the presence or absence of visceral and bony injury, identifying injury requiring close monitoring and operative intervention, detecting active hemorrhage and estimating associated blood loss. The use of CT as the primary screening modality in the assessment of injured children, along with improvements in supportive care, has played a critical role in the success of nonoperative management of solid viscus injuries. The rapid evaluation of injured children with CT has also resulted in improved triage and has contributed to reduced morbidity and mortality.

The decision for operative intervention in the small percentage of children who require surgical hemostasis is primarily made based on clinical criteria, not CT findings.[7] Therefore, CT primarily guides nonoperative decisions, such as duration of hospitalization, intensity of care, and length of activity restriction.

It has been shown that solid viscus injury grading at CT is useful for estimating the time course of healing.[36–40] However, follow-up imaging of solid viscus injury is not indicated in asymptomatic children for several reasons. First, no injury progression or complication is noted in most cases of solid viscus injury. Second, clinical management is rarely altered based on follow-up imaging.

Finally, a negative CT also serves an important function in excluding an intra-abdominal or pelvic source of blood loss, thus enabling early discharge of the child from the hospital without further observation.[41] The high negative predictive value of CT indicates that hospital admission or observation is not necessary for patients with suspected blunt abdominal injury and a negative abdominal CT.[41–42]

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