Skip to main content
NCBI home page
Annals of Surgery logoLink to Annals of Surgery
. 1993 Mar;217(3):272–276. doi: 10.1097/00000658-199303000-00009

Computed tomography in the evaluation of children with blunt abdominal trauma.

D M Meyer 1, E R Thal 1, D Coln 1, J A Weigelt 1
PMCID: PMC1242780  PMID: 8452405

Abstract

OBJECTIVE: This study determined the sensitivity, specificity, and accuracy of CT in pediatric patients with blunt trauma. Correlation of the CT-identified injuries and intraoperative findings with comparison to the results of DPL was performed. SUMMARY BACKGROUND DATA: Clinical evaluation frequently is unreliable in determining the presence of intra-abdominal injury in children with blunt trauma. Peritoneal lavage has been used to establish the need for operative intervention and has been found to be safe, efficient, and reliable (98%). In many institutions, abdominal CT scans are used to evaluate these children. Because most reports involve nonoperative management, operative confirmation of CT-identified injuries is available only for those children in whom nonoperative treatment is unsuccessful. METHODS: Sixty children sustaining blunt abdominal trauma were included in the study. CT scans with both oral and IV contrast were performed before open lavage, and positive results were confirmed by operation in 18 patients. RESULTS: CT had a sensitivity of 67%, however, only 60% of the actual organ injuries were identified by the scan. In contrast, DPL has a sensitivity of 94%. Both studies were equally specific (100%). DPL was also more accurate, 98% as compared with 89% for CT. CONCLUSIONS: Although the abdominal CT scan is useful in evaluating children with blunt abdominal trauma, a number of significant injuries were missed. Based on the low sensitivity of the CT, the authors suggest diagnostic peritoneal lavage may offer advantages over CT as the initial study in the evaluation of children with blunt abdominal trauma.

Full text

PDF
272

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Berger P. E., Kuhn J. P. CT of blunt abdominal trauma in childhood. AJR Am J Roentgenol. 1981 Jan;136(1):105–110. doi: 10.2214/ajr.136.1.105. [DOI] [PubMed] [Google Scholar]
  2. Brick S. H., Taylor G. A., Potter B. M., Eichelberger M. R. Hepatic and splenic injury in children: role of CT in the decision for laparotomy. Radiology. 1987 Dec;165(3):643–646. doi: 10.1148/radiology.165.3.3685344. [DOI] [PubMed] [Google Scholar]
  3. Brody A. S., Seidel F. G., Kuhn J. P. CT evaluation of blunt abdominal trauma in children: comparison of ultrafast and conventional CT. AJR Am J Roentgenol. 1989 Oct;153(4):803–806. doi: 10.2214/ajr.153.4.803. [DOI] [PubMed] [Google Scholar]
  4. Cox E. F. Blunt abdominal trauma. A 5-year analysis of 870 patients requiring celiotomy. Ann Surg. 1984 Apr;199(4):467–474. doi: 10.1097/00000658-198404000-00015. [DOI] [PMC free article] [PubMed] [Google Scholar]
  5. DuPriest R. W., Jr, Rodriguez A., Shatney C. H. Peritoneal lavage in children and adolescents with blunt abdominal trauma. Am Surg. 1982 Sep;48(9):460–462. [PubMed] [Google Scholar]
  6. Fabian T. C., Mangiante E. C., White T. J., Patterson C. R., Boldreghini S., Britt L. G. A prospective study of 91 patients undergoing both computed tomography and peritoneal lavage following blunt abdominal trauma. J Trauma. 1986 Jul;26(7):602–608. doi: 10.1097/00005373-198607000-00003. [DOI] [PubMed] [Google Scholar]
  7. Federle M. P., Crass R. A., Jeffrey R. B., Trunkey D. D. Computed tomography in blunt abdominal trauma. Arch Surg. 1982 May;117(5):645–650. doi: 10.1001/archsurg.1982.01380290091016. [DOI] [PubMed] [Google Scholar]
  8. Fischer R. P., Beverlin B. C., Engrav L. H., Benjamin C. I., Perry J. F., Jr Diagnostic peritoneal lavage: fourteen years and 2,586 patients later. Am J Surg. 1978 Dec;136(6):701–704. doi: 10.1016/0002-9610(78)90339-2. [DOI] [PubMed] [Google Scholar]
  9. Fischer R. P., Miller-Crotchett P., Reed R. L., 2nd Gastrointestinal disruption: the hazard of nonoperative management in adults with blunt abdominal injury. J Trauma. 1988 Oct;28(10):1445–1449. [PubMed] [Google Scholar]
  10. Goldstein A. S., Sclafani S. J., Kupferstein N. H., Bass I., Lewis T., Panetta T., Phillips T., Shaftan G. W. The diagnostic superiority of computerized tomography. J Trauma. 1985 Oct;25(10):938–946. doi: 10.1097/00005373-198510000-00003. [DOI] [PubMed] [Google Scholar]
  11. Haftel A. J., Lev R., Mahour G. H., Senac M., Akhtar Shah S. I. Abdominal CT scanning in pediatric blunt trauma. Ann Emerg Med. 1988 Jul;17(7):684–689. doi: 10.1016/s0196-0644(88)80611-5. [DOI] [PubMed] [Google Scholar]
  12. Jeffrey R. B., Jr, Federle M. P., Crass R. A. Computed tomography of pancreatic trauma. Radiology. 1983 May;147(2):491–494. doi: 10.1148/radiology.147.2.6836127. [DOI] [PubMed] [Google Scholar]
  13. Kane N. M., Cronan J. J., Dorfman G. S., DeLuca F. Pediatric abdominal trauma: evaluation by computed tomography. Pediatrics. 1988 Jul;82(1):11–15. [PubMed] [Google Scholar]
  14. Marx J. A., Moore E. E., Jorden R. C., Eule J., Jr Limitations of computed tomography in the evaluation of acute abdominal trauma: a prospective comparison with diagnostic peritoneal lavage. J Trauma. 1985 Oct;25(10):933–937. doi: 10.1097/00005373-198510000-00002. [DOI] [PubMed] [Google Scholar]
  15. Mohamed G., Reyes H. M., Fantus R., Ramilo J., Radhakrishnan J. Computed tomography in the assessment of pediatric abdominal trauma. Arch Surg. 1986 Jun;121(6):703–707. doi: 10.1001/archsurg.1986.01400060099014. [DOI] [PubMed] [Google Scholar]
  16. Olsen W. R., Hildreth D. H. Abdominal paracentesis and peritoneal lavage in blunt abdominal trauma. J Trauma. 1971 Oct;11(10):824–829. doi: 10.1097/00005373-197110000-00002. [DOI] [PubMed] [Google Scholar]
  17. Peitzman A. B., Makaroun M. S., Slasky B. S., Ritter P. Prospective study of computed tomography in initial management of blunt abdominal trauma. J Trauma. 1986 Jul;26(7):585–592. doi: 10.1097/00005373-198607000-00001. [DOI] [PubMed] [Google Scholar]
  18. Powell R. W., Green J. B., Ochsner M. G., Barttelbort S. W., Shackford S. R., Sise M. J. Peritoneal lavage in pediatric patients sustaining blunt abdominal trauma: a reappraisal. J Trauma. 1987 Jan;27(1):6–9. doi: 10.1097/00005373-198701000-00002. [DOI] [PubMed] [Google Scholar]
  19. Rodriguez A., DuPriest R. W., Jr, Shatney C. H. Recognition of intra-abdominal injury in blunt trauma victims. A prospective study comparing physical examination with peritoneal lavage. Am Surg. 1982 Sep;48(9):457–459. [PubMed] [Google Scholar]
  20. Rothenberg S., Moore E. E., Marx J. A., Moore F. A., McCroskey B. L. Selective management of blunt abdominal trauma in children--the triage role of peritoneal lavage. J Trauma. 1987 Oct;27(10):1101–1106. doi: 10.1097/00005373-198710000-00001. [DOI] [PubMed] [Google Scholar]
  21. Sherck J. P., Oakes D. D. Intestinal injuries missed by computed tomography. J Trauma. 1990 Jan;30(1):1–7. doi: 10.1097/00005373-199001000-00001. [DOI] [PubMed] [Google Scholar]
  22. Taylor G. A., Eich M. R. Abdominal CT in children with neurologic impairment following blunt trauma. Abdominal CT in comatose children. Ann Surg. 1989 Aug;210(2):229–233. doi: 10.1097/00000658-198908000-00016. [DOI] [PMC free article] [PubMed] [Google Scholar]
  23. Taylor G. A., Fallat M. E., Potter B. M., Eichelberger M. R. The role of computed tomography in blunt abdominal trauma in children. J Trauma. 1988 Dec;28(12):1660–1664. doi: 10.1097/00005373-198812000-00008. [DOI] [PubMed] [Google Scholar]
  24. Thal E. R. Peritoneal lavage. Reliability of RBC count in patients with stab wounds to the chest. Arch Surg. 1984 May;119(5):579–584. doi: 10.1001/archsurg.1984.01390170075015. [DOI] [PubMed] [Google Scholar]
  25. Thal E. R., Shires G. T. Peritoneal lavage in blunt abdominal trauma. Am J Surg. 1973 Jan;125(1):64–69. doi: 10.1016/0002-9610(73)90009-3. [DOI] [PubMed] [Google Scholar]

Articles from Annals of Surgery are provided here courtesy of Lippincott, Williams, and Wilkins

RESOURCES