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Understanding abdominal pelvic computerized tomography scan usage amongst adolescent blunt trauma patients treated at adult trauma centers

      Highlights

      • Prevalence of APCT within the adolescent blunt trauma population was found to be 59.3% (95% CI 54.2%-64.9%).
      • Of the patients who received APCT, 123 (37.9%) had positive findings on APCT with 65 (20.0%) having intraabdominal injury.
      • Of patients who received APCT 25 (7.7%) had injury that required abdominal surgery.
      • 100% of patients with intraabdominal injury had at least one clinical predictor for intraabdominal injury while 28.7% of patients without intraabdominal injury who received APCT lacked any key predictors.
      • Abnormal abdominal exam, positive chest x-ray, positive or indeterminate FAST, elevated AST and elevated ALT were independently associated with intraabdominal injury.

      Abstract

      Introduction

      The algorithm for evaluating adolescent patients with blunt trauma includes abdominal pelvic CT (APCT). The aim of this study is to evaluate the utility of APCT in this context.

      Methods

      We performed a retrospective review of adolescent (11 to 18 years of age) blunt trauma patients at an urban adult level 1 trauma center from January 2015 to December 2019. The primary outcome was the prevalence of positive findings on APCT scan.  Additionally, clinical risk factors concerning for intra-abdominal injury were analyzed.

      Results

      There were 546 patients evaluated for blunt trauma and the prevalence of APCT within the population was 59.3% (95% CI 54.2%-64.9%). Of the patients who received APCT, 123 (37.9%) had positive findings on APCT. Only 25 patients (7.7% of those who underwent APCT) required abdominal surgery while 40 patients (12.3%) had intraabdominal injury that did not require surgery. Risk factors were present in 100% of patients with intraabdominal injury and absent in 28.7% of patients without intraabdominal injury. Abnormal abdominal exam, abnormal FAST, positive chest x-ray and elevated transaminases were independently associated with intraabdominal injury.

      Conclusions

      Our study found that adolescent blunt trauma patients treated at our trauma center had a higher rate of APCT usage, but a comparable rate of positive findings when compared with the most recent literature. Future studies should focus on reducing the number of patients who undergo APCT despite an absence of clinical risk factors.

      Keywords

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