O. Hopper1, S. Jain1, B. K. Yorkgitis1 1University of Florida College of Medicine-Jacksonville, Department Of Surgery, Jacksonville, FL, USA
Introduction: Seat belt signabdominal wall bruising in pediatric trauma is associated with intraabdominal injury (IAI). CT scan is often performed to screen for IAI. CT scans expose children to radiation that can contribute to future malignancy and miss hollow viscus injuries (HVI). Blunt abdominal trauma (BAT) screening protocols have been developed to decrease CT scans. Applying these protocols along with observation to pediatric patients with seat belt sign/abdominal wall bruising may reduce CT use.
Methods: A retrospective review of pediatric trauma patients (<15 years) with normal GCS and hemodynamically normal for age with an abdominal seat belt signabdominal bruising presenting to an Adult/Pediatric Level 1 trauma center during a 5-year period was undertaken.
Results: 92 patients met the inclusion criteria for analysis. The age range was 1 to 14 years (mean 8.2 years). No CT abdomen was performed in 63 patients of which 10 had at least one BAT test above threshold but no abdominal concerning signs or traumatic findings on x-ray (chest and/or pelvis). 29 patients received a CT, of which 11 were screened with our BAT protocol prior to decision for CT. Among patients screened with the BAT protocol prior to CT, all had BAT labs above threshold, traumatic finding on x-rays, or development of concerning signs/symptoms in which 5 (45.5%) were identified to have IAI on CT. None required intervention. In the 18 patients receiving immediate CT, 7 (38.9%) had IAI, all requiring intervention (IAI-I). Each IAI-I patient had a concerning exam, 4 had BAT labs above threshold or traumatic finding on x-ray, 1 patient had a normal CT but HVI on exploration.
Conclusion:
In stable blunt pediatric patients with abdominal wall bruising, screening labs and observation can be used to assist trauma teams in decisions to perform CT scan to reduce exposure to ionizing radiation in patients with bruising but no other concerning findings. Surgeons identified all patients with IAI-I as needing an immediate CT. Further prospective studies are needed to validate these findings in a larger cohort.
