L.Y. Kwak1, T. Wang1, S. Burjonrappa1 1Robert Wood Johnson Medical School- Rutgers, New Brunswick, NJ, USA
Introduction:
The spleen and liver are the most injured organs in pediatric blunt abdominal trauma that can lead to life-threatening hemorrhage. Appropriate imaging via ultrasonography (US) and computed tomography (CT) is essential in identifying the need for operative management in the pediatric BLSI (Blunt Liver and Spleen Injury) patients to prevent bleeding complications. Studies have shown increased cancer risks associated with repeated CT use in pediatric patients, but the extent to which CT utilization should be reduced is still unclear. This study aimed to compare pediatric patients who received US only and those who received US followed by CT to determine if imaging modality is associated with clinical outcomes.
Methods:
The National Trauma Data Bank (NTDB) was queried for patients ≤ 18 years admitted between 2017-2019 with BLSI who received US and/or CT imaging. Patients with non-blunt injuries; concomitant non-abdominal injuries with AIS score ≥ 3; who received CT imaging only; and/or received CT followed by US were excluded. Included patients received US imaging only, or US followed by CT. Baseline characteristics and clinical outcomes were compared between these groups. Primary outcomes measured were incidences of embolization and laparotomy for hemorrhage control. Secondary outcomes measured were mortality; ICU admission; ICU length of stay (LOS); and hospital LOS.
Results:
5685 patients ages ≤ 18 presented with isolated BLSI and received US and/or CT during the study period. 3566 patients were excluded for receiving CT only or receiving CT followed by US. 2119 patients remained; 868/2119 (41%) received US only, and 1251/2119 (59%) received US followed by CT. Baseline comparison identified lower injury severity score in patients who received US only (10 vs. 12, p<0.01). Between groups, no significant differences existed in incidences of embolization (2% vs. <1%, p=0.16) or laparotomy (4% vs. 3%, p=0.70). Patients who received US only had a higher incidence of mortality (2% vs. <1%, p<0.001); shorter ICU LOS (median 2 days vs. 2, p<0.005); and shorter hospital LOS (3 days vs. 4, p<0.001). ICU admission was similar between groups (46% vs. 49%, p=0.18).
Conclusion:
The addition of CT imaging to US did not make a significant difference in decision-making for operative management in pediatric BLSI patients. It appears that Level I centers and non-pediatric verified centers have a higher US followed by CT protocol. Further study is needed to determine the use of US and FAST in managing BLSI. Improved guidelines are necessary to determine the exact use of cross-sectional imaging after initial US in BLSI patients.