CT Timing Affects Injury Assessment in Pediatric Trauma

TOPLINE:

Children with blunt abdominal trauma (BAT) and positive CT scans for abdomen/pelvis (CT a/p) have more severe injuries and longer hospital stays, whereas those with negative scans may not require transfer to a trauma center, a study suggests.

METHODOLOGY:

• This retrospective analysis included 923 pediatric patients (mean age, 8.2 years; 60.8% men; 59.4% White) with BAT who were transferred from outside facilities (OSFs) to a Level-1 pediatric trauma center (PTC) between 2009 and 2019, using data from electronic medical records and a trauma registry.
• Data collected included demographics, injury mechanisms, Glasgow Coma Scale (GCS) scores, Injury Severity Scale ( ISS) scores, disposition, and length of stay (LOS); patients were categorized on the basis of whether they underwent CT a/p at an OSF (n = 499) or a PTC (n = 424), with outcomes compared among those with positive CT a/p results at an OSF (n = 433) and a PTC (n = 156).
• The primary outcome was to describe pediatric patients with BAT transferred to a Level-1 PTC; secondary outcomes included comparisons of CT a/p use, results, interventions, and patient disposition.

TAKEAWAY:

• Patients who underwent CT a/p at an OSF were admitted to a PTC more frequently (93.4%) and required more intensive care (surgery or admission to an intensive care unit) than those who did not undergo CT a/p (73.4%; P
• Additionally, patients with CT a/p at an OSF had a higher average age than those without scans (9.0 vs 7.2 years; P P
• Boys had higher rates of positive CT a/p results (P = .0012), with motor vehicle crashes being the most common cause of injury (P = .0002). Positive CT a/p results at a PTC were associated with increased ISS scores (P = .001), lower GCS scores (P P 

IN PRACTICE:

“Compared to those with positive CT a/p at OSF, children who had positive CT a/p at PTC were younger, had higher ISS scores, and longer LOS, suggesting they were more seriously injured. Additionally, patients with a negative CT a/p who were admitted to our PTC had short LOS and very low rates of ICU [intensive care unit] or OR [operating room] utilization,” the authors wrote.

SOURCE:

The study was led by Shannon E. Yancovich, MD, Department of Pediatric Emergency Medicine, University of Texas Southwestern Medical Center, Dallas, and was published online on November 23, 2024, in The American Journal of Emergency Medicine.

LIMITATIONS:

Missing data may have limited the depth of the analysis, resulting in limited information from OSFs or emergency medical services. Furthermore, the exclusion criteria did not account for coexisting conditions that could influence admission rates, and the method used to assign ISS scores to dead patients may have limited the generalizability of some findings.

DISCLOSURES:

The study received no external funding. No conflicts of interest were disclosed by the authors.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.