Article

Role of Computed Tomography and Clinical Findings in Pediatric Blunt Intestinal Injury A Multicenter Study

From the Division of Pediatric and Thoracic Surgery, Department of Surgery, Cincinnati Children's Hospital Medical Center, College of Medicine, University of Cincinnati, Cincinnati, OH.
Pediatric emergency care (Impact Factor: 1.05). 11/2012; 28(12). DOI: 10.1097/PEC.0b013e318276c057
Source: PubMed

ABSTRACT

Purpose:
Although computed tomographic (CT) scans are accurate in diagnosing solid-organ injuries, their ability to diagnose a blunt intestinal injury (BII) is limited, occasionally requiring repeated imaging. The purpose of this study was to evaluate the role of clinical findings as well as original and repeated CT imaging in the ultimate decision to operate for BII.

Methods:
An 18-institution record review of children (≤ 15 years) diagnosed with a BII confirmed during surgery between 2002 and 2007 was conducted by the American Pediatric Surgery Association Trauma Committee. The incidence of imaging, repeated imaging, and final reported indications for operative exploration were evaluated.

Results:
Among 331 patients identified with a BII, 292 (88%) underwent at least 1 abdominal CT scan. Sixty-two (19%) underwent at least 1 repeated scan before operation. Forty-seven percent of children who underwent a CT scan were taken to the operating room based primarily on clinical indications (fever, abdominal pain, shock or elevated white blood cell count), whereas 31% were operated on based on both a clinical and CT indication and 22% were operated on based on a CT indication alone (P < 0.001). Although free air was the most common radiographic indication for surgery, 13% of patients with a repeated scan had free air diagnosed on their first CT. Most children undergoing a repeated CT (84%) had findings on the original scan suggesting a BII. Among the 10 patients whose first CT scan result was normal, only 1 went to the operating room based only on radiographic findings. Children who had their first CT scan at a referring hospital were more likely to have a repeated study compared with those imaged at a trauma center (33% vs 13%, P < 0.0001).

Conclusions:
Although abdominal CT imaging may contribute to diagnosing intestinal injury after blunt trauma, most children undergo operation based on clinical findings. Repeated imaging should be limited to select patients with diagnostic uncertainty to avoid unneeded delay and radiation exposure.

1 Follower
 · 
23 Reads
  • [Show abstract] [Hide abstract]
    ABSTRACT: Abdominal injuries in childhood are among serious and, not uncommonly, life-threatening conditions. They are often a part of polytrauma and associated injuries in which trauma to abdominal organs may be overlooked. In childhood, blunt abdominal injuries significantly prevail over open injuries. The present case reports demonstrate cases that are less common, whether in terms of the etiology of injury, diagnosis or treatment and consequences.
    No preview · Article · Jan 2013 · Pediatrie pro Praxi
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Trauma is the leading cause of morbidity and mortality in children. Computed tomography examinations play an important role in the management of patients with major trauma. Though abdominal trauma is less common compared to head injuries, the associated morbidity and mortality are substantial. It is easier to diagnose solid abdominal injuries than intestinal or mesenteric injuries on CT examinations. However, recognition of bowel injury is very important as a delay in diagnosis increases the morbidity and mortality. Hence, with every CT of the abdomen and pelvis, the radiologist must look for signs of bowel and mesenteric injury. This pictorial review presents various CT findings of blunt intestinal injury in children.
    Full-text · Article · Apr 2013 · Emergency Radiology
  • [Show abstract] [Hide abstract]
    ABSTRACT: Thoracic and abdominal injuries in children are commonly the result of blunt trauma, making their diagnosis difficult. Unidentified injuries can cause significant morbidity and mortality and must be identified early. Understanding the anatomic and physiologic differences between children and adults is important to adequately manage children with these injuries. The following review provides salient points in the recognition and management of both thoracic and abdominal injuries in children from blunt trauma.
    No preview · Article · Jun 2013 · Minerva chirurgica
Show more