Seven factors rule out CT for children with abdominal injury

By Helen Albert, Senior medwireNews Reporter

Research shows that children presenting with abdominal injury at an emergency department who lack seven key factors are extremely unlikely to have an injury requiring acute intervention and therefore do not require computed tomography (CT) scanning.

"CT scans involve significant radiation risk, especially for children, who are more vulnerable than adults to radiation's effects," said lead author of the Annals of Emergency Medicine study James Holmes (University of California Davis School of Medicine, Sacramento, USA) in a press statement.

"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," he added.

Holmes and colleagues enrolled 12,044 children, aged a median of 11.1 years, admitted to 20 emergency departments in the USA with blunt torso trauma between May 2007 and January 2010. Overall, 761 (6.3%) of the children had intra-abdominal injuries. Of these, 203 (26.7%) required and received acute interventions including therapeutic laparotomy, angiographic embolization, or blood transfusion for abdominal hemorrhage.

The researchers calculated that children who had no evidence of abdominal wall trauma or seat belt marks, had a Glasgow Coma Scale score above 13, did not have abdominal tenderness, did not complain of abdominal pain, had no evidence of thoracic wall trauma, did not have decreased breathing sounds, and were not vomiting only had a 0.1% chance of having intra-abdominal injury requiring intervention. In these children a CT scan is unlikely to provide useful clinical information, say the authors.

Indeed, they suggest that the chance of developing cancer due to CT-related radiation exposure in children who are negative for all seven factors is likely to be greater than their risk for having intra-abdominal injury requiring intervention.

The seven-factor rule was correct in predicting no acute abdominal injury in 99.9% of 5034 cases, accurately predicted such injury in 97% of the 203 children who required intervention, and accurately predicted no injury in 42.5% of 11,841 children who did not require intervention.

Holmes and team note that while absence of all seven factors can help clinicians rule out the need for a CT scan, presence of one or more of these factors does not mean a scan is essential and they emphasize the value of clinical judgment on a case by case basis.

They conclude: "These findings require external validation before implementation."

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