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

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.