The role of computed tomography in the evaluation of blunt abdominal trauma in children

Computed tomography was used in the evaluation and follow-up of blunt intra-abdominal injuries in 46 children. The use of this modality resulted in a rapid and accurate diagnosis in the patients studied. Indications for CT scan examination included: a stable clinical state, symptoms and signs suggestive of intra-abdominal injury, hypotension responding to minimal fluid resuscitation, slowly declining hematocrit, hematuria, or suspicious radiographs. Patients with unstable vital signs were not considered candidates for CT scanning. The value of the protocol and CT scanning procedure itself was evident by the high yield of positive results (74% of the patients studied). Of the 12 children with urologic trauma, 2 had severe renal injuries that were not suspected by infusion i.v. pyelography and in one instance by arteriography. The magnitude and extent of perirenal hemorrhage was easily demonstrated. Thirteen patients had splenic lacerations, while 7 children had suspected hepatic injuries all accurately demonstrated by CT scans. Intra-peritoneal blood was easily detected. Two patients had pancreaticoduodenal injuries. Eleven of 12 renal injuries, 9 of 13 splenic lacerations, 5 of 7 hepatic injuries, and both pancreaticoduodenal injuries were successfully treated nonoperatively. The appropriateness of conservative management was substantiated by periodic follow-up examinations. This study demonstrated the improved sensitivity of CT scanning and ability to visualize intra- and retroperitoneal structures simultaneously when compared to more conventional methods of radiographic evaluation. The applications of CT scanning in the evaluation of the traumatized patient reduces the number of ancillary tests required for diagnosis, provides more accurate information regarding the extent and severity of the injury, and results in more appropriate decisions regarding the need for exploration versus nonoperative management. In addition, this modality offers an accurate method for long-term follow-up, allowing definitive recommendations concerning activities.