Prospective evaluation of an evidence-based decision tool to assess pediatric blunt abdominal trauma (BAT)

Pediatr Surg Int. 2022 Jan;38(1):183-191. doi: 10.1007/s00383-021-05013-x. Epub 2021 Sep 29.

Abstract

Purpose: Computed tomography (CT) is currently the standard for evaluation of intra-abdominal injury (IAI) after BAT. Pediatric patients receiving CT scans based on adult clinical protocols are potentially exposed to unnecessary radiation. The purpose of this study is to determine the rate of CT scans before and after implementation of a pediatric BAT decision tool.

Methods: We adapted and implemented an evidence-based decision tool for pediatric BAT based on five clinical variables. We reviewed patient charts 18 months pre- and post-implementation. Demographics and outcomes were compared using Chi-square and Fisher's exact test, accordingly.

Results: The pre and post-implementation groups were uniform when comparing age, sex, mechanism, and Injury Severity Score. The decision tool was utilized in 85% of patients post-implementation. Fewer CT scans were obtained in the post-implementation group (28 vs. 21%, p = 0.215) with no missed injuries or late diagnoses.

Conclusion: Implementation of a pediatric BAT decision tool decreased CT usage and radiation exposure without an obvious compromise to patient care. This experience supports the utilization of these tools for the assessment of IAI after BAT and have resulted in more selective use of CT during pediatric BAT in our program.

Keywords: Blunt abdominal trauma; Computed tomography (CT); Decision tool; Pediatric trauma.

MeSH terms

  • Abdominal Injuries* / diagnostic imaging
  • Adult
  • Child
  • Humans
  • Injury Severity Score
  • Radiation Exposure*
  • Retrospective Studies
  • Tomography, X-Ray Computed
  • Wounds, Nonpenetrating* / diagnostic imaging