Prediction rule can help pediatric trauma patients avoid CT scans

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Researchers have identified several factors physicians should consider in helping them decide whether or not to perform a CT scan on young traumatic injury victims.

The prospective study, reported online in the Annals of Emergency Medicine, involved evaluating children who arrived at emergency departments in the Pediatric Emergency Care Applied Research Network (PECARN) after blunt trauma to their torsos, such as that caused by a fall or car or bicycle crash. Of the more than 12,000 children evaluated, 761 were diagnosed with intra-abdominal injuries, and 203 received acute interventions.

According to the study, factors related to the children's histories and clinical presentations were evaluated. Seven of those were identified as correlating with a risk of significant injury, including evidence of trauma to the abdomen or chest, neurological changes, abdominal pain or tenderness, abnormal breathing and vomiting.

The researchers found that children who presented with none of those factors had a 0.1 percent chance of having an abdominal injury requiring acute intervention. That means, the study's authors concluded, that the risk of developing any future cancer from performing a CT scan in that kind of situation was greater than the risk of having a significant medical issue from the abdominal injury.

"CT scans involve significant radiation risk, especially for children, who are more vulnerable than adults to radiation's effects,"  principal investigator and lead author James Holmes, a professor of emergency medicine at the University of California Davis School of Medicine, said in an announcement. "We have now identified a population of pediatric patients that does not typically benefit from a CT scan, which is an important step in reducing radiation exposure."

To learn more:
- see the study abstract
- read the announcement

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