A study of more than 12,000 children from emergency departments throughout the country in the Pediatric Emergency Care Applied Research Network (PECARN) has identified seven factors that can help physicians determine the need for a computed tomography (CT) scan following blunt trauma to the abdomen. Because CT scans pose radiation hazards for youngsters, the findings may enable doctors to determine which children do not need to be exposed to such tests after a traumatic injury.
The study, titled "Identifying children at very low risk of clinically important blunt abdominal injuries," is online first in advance of an upcoming issue of the Annals of Emergency Medicine."
"CT scans involve significant radiation risk, especially for children, who are more vulnerable than adults to radiation's effects," said principal investigator and lead author of the study James Holmes, a professor of emergency medicine at the UC Davis School of Medicine. "We have now identified a population of pediatric patients that does not typically benefit from a CT scan, which is an important step in reducing radiation exposure."
The prospective study involved children who arrived at emergency departments in the PECARN network after blunt trauma to their torsos, such as sustained from a car or bicycle crash, a fall or an assault. A variety of factors related to the children's histories and clinical presentations were evaluated. Among these, seven were identified by statistical analysis to correlate with risk for involving a clinically important injury. The factors included evidence of trauma on the abdomen or chest (such as seat-belt marks), neurological changes, abdominal pain or tenderness, abnormal breath sounds and vomiting.
Children who had none of the factors when evaluated in the emergency department had only a 0.1 percent chance of having an abdominal injury that required acute intervention. For the great majority of these cases, therefore, a CT scan would not likely provide additional useful information. According to the authors, the risk of developing a future cancer from radiation exposure from a CT scan in this situation (i.e., when lacking all seven factors) outweighs the risk of having a significant medical problem from the abdominal injury.