S. N. Acker1, C. L. Stewart1, G. E. Roosevelt3, D. A. Partrick1, D. D. Bensard1,2 1Children’s Hospital Colorado,Pediatric Surgery,Aurora, CO, USA 2Denver Health Medical Center,Department Of Surgery,Aurora, CO, USA 3Denver Health Medical Center,Pediatric Emergency Medicine,Aurora, CO, USA
Introduction: CT scan is the gold standard to diagnose solid organ injury following blunt trauma. However, the radiation risks associated with abdominal CT scan include a 2-3:1000 risk of cancer, with younger age correlating to higher malignancy risk. We hypothesized that there are patient specific factors, including GCS on presentation, pediatric age adjusted shock index (heart rate/systolic blood pressure) (SIPA), and mechanism of injury, that can help identify those patients with low-grade injury who can be treated safely without need for a CT diagnosis. We have previously shown that SIPA accurately identifies severely injured children following blunt trauma and hypothesized that SIPA would help to identify children with severe solid organ injury at high risk of requiring intervention.
Methods: We performed a retrospective review of all children admitted to two pediatric trauma centers following blunt trauma with any grade liver or spleen injury from 1/09-12/13. Data collected include SIPA and GCS on presentation, mechanism of injury, injury severity score (ISS), need for interventions including red blood cell (PRBC) transfusion or laparotomy, and outcomes such as hospital length of stay (LOS) and discharge disposition. The Low Risk Group was defined as GCS 15 with normal SIPA on presentation, and injury attributable to a single, non-motorized, blunt force to the abdomen. The Non-Low Risk Group did not meet these criteria.
Results:101 out of 206 children met the low risk criteria. Patients in the Low Risk Group were older than those in Non-Low Risk Group (median age 11 years vs 9 years, p=0.01), were more likely to be male (75% vs 60%; p=0.02) and have a lower ISS (median 9 versus 17; p<0.001).
Conclusion:Children, who present to the emergency department following blunt abdominal trauma by a non-motorized force with a normal GCS and SIPA, are unlikely to have a solid organ injury that will require intervention. When treating patients who meet these criteria, clinicians can have an open dialogue with a child’s parents regarding the necessity of abdominal CT and the potential yield, particularly with regard to whether the CT scan will lead to a change in patient management. Moreover, in children with normal SIPA and GCS on presentation, our pilot study suggests that this group may be managed with a period of observation, imaging only for changes in clinical parameters, and recommendations for a short period of activity restriction following discharge thus, obviating the need for abdominal CT reducing cost and radiation exposure.
