Indications for Computed Tomography in Children with Blunt Abdominal Trauma
GEORGE A. TAYLOR, M.D.,* MARTIN R. EICHELBERGER, M.D.,t REGINA O'DONNELL, B.A.,4 and LEON BOWMAN, B.A.t From the Departments of Radiology and Diagnostic Imaging,* Surgery,t and Research,* Children's National Medical Center, and The George Washington University School of Medicine and Health Sciences, Washington, D.C.
This investigation was undertaken to identify clinical variables, alone or in combination, that could be used to assign children to high- and low-risk categories for intra-abdominal injury following blunt trauma. Six hundred consecutive children who were examined with computed tomography (CT) following blunt trauma were enrolled. Complete data sets were available on 375 children. Stepwise logistic regression was used to identify predictor variables for the presence of abdominal injury. There were 174 children with abdominal injury detected by CT. Of these, 95 were classified as having significant injury. Indicators associated with significantly higher risk of abdominal injury included the following: more than three clinical indications given (odds likelihood ratio IOLRI = 4.60, 95% confidence interval 195% Cli = 2.29, 9.21, p < 0.001); gross hematuria (OLR = 5.80,95% Cl = 2.51, 13.4, p < 0.001); lap belt injury (OLR = 12.2, 95% Cl = 2.22, 66.8, p < 0.01); assault or abuse as the mechanism of injury (OLR = 5.08, 95% Cl = 1.07, 24.2, p < 0.05); abdominal tenderness (OLR = 2.73, 95% Cl = 1.296, 5.82, p < 0.01); and Trauma Score