Prospective Evaluation of an Evidence-based Decision Tool to Assess Pediatric Blunt Abdominal Trauma (BAT)

Overview

Journal Pediatr Surg Int

Specialties General Surgery
Pediatrics

Date 2021 Sep 29

PMID 34586483

Citations 3

Authors

Elizabeth Boudiab

Samer Kawak

Alan Tom

Diane Studzinski

Nathan Novotny

Pavan Brahmamdam

Begum Akay

Affiliations

Soon will be listed here.

Abstract

Purpose: Computed tomography (CT) is currently the standard for evaluation of intra-abdominal injury (IAI) after BAT. Pediatric patients receiving CT scans based on adult clinical protocols are potentially exposed to unnecessary radiation. The purpose of this study is to determine the rate of CT scans before and after implementation of a pediatric BAT decision tool.

Methods: We adapted and implemented an evidence-based decision tool for pediatric BAT based on five clinical variables. We reviewed patient charts 18 months pre- and post-implementation. Demographics and outcomes were compared using Chi-square and Fisher's exact test, accordingly.

Results: The pre and post-implementation groups were uniform when comparing age, sex, mechanism, and Injury Severity Score. The decision tool was utilized in 85% of patients post-implementation. Fewer CT scans were obtained in the post-implementation group (28 vs. 21%, p = 0.215) with no missed injuries or late diagnoses.

Conclusion: Implementation of a pediatric BAT decision tool decreased CT usage and radiation exposure without an obvious compromise to patient care. This experience supports the utilization of these tools for the assessment of IAI after BAT and have resulted in more selective use of CT during pediatric BAT in our program.

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References

Wegner S, Colletti J, Van Wie D . Pediatric blunt abdominal trauma. Pediatr Clin North Am. 2006; 53(2):243-56. DOI: 10.1016/j.pcl.2006.02.002. View

Larson D, Johnson L, Schnell B, Salisbury S, Forman H . National trends in CT use in the emergency department: 1995-2007. Radiology. 2010; 258(1):164-73. DOI: 10.1148/radiol.10100640. View

Tillou A, Gupta M, Baraff L, Schriger D, Hoffman J, Hiatt J . Is the use of pan-computed tomography for blunt trauma justified? A prospective evaluation. J Trauma. 2009; 67(4):779-87. DOI: 10.1097/TA.0b013e3181b5f2eb. View

Larson D, Johnson L, Schnell B, Goske M, Salisbury S, Forman H . Rising use of CT in child visits to the emergency department in the United States, 1995-2008. Radiology. 2011; 259(3):793-801. DOI: 10.1148/radiol.11101939. View

Streck C, Vogel A, Zhang J, Huang E, Santore M, Tsao K . Identifying Children at Very Low Risk for Blunt Intra-Abdominal Injury in Whom CT of the Abdomen Can Be Avoided Safely. J Am Coll Surg. 2017; 224(4):449-458.e3. DOI: 10.1016/j.jamcollsurg.2016.12.041. View

Arbra C, Vogel A, Plumblee L, Zhang J, Mauldin P, Dassinger M . External validation of a five-variable clinical prediction rule for identifying children at very low risk for intra-abdominal injury after blunt abdominal trauma. J Trauma Acute Care Surg. 2018; 85(1):71-77. DOI: 10.1097/TA.0000000000001933. View

Karam O, Sanchez O, Chardot C, La Scala G . Blunt abdominal trauma in children: a score to predict the absence of organ injury. J Pediatr. 2009; 154(6):912-7. DOI: 10.1016/j.jpeds.2009.01.001. View

de Jong W, Stoepker L, Nellensteijn D, Groen H, El Moumni M, Hulscher J . External validation of the Blunt Abdominal Trauma in Children (BATiC) score: ruling out significant abdominal injury in children. J Trauma Acute Care Surg. 2014; 76(5):1282-7. DOI: 10.1097/TA.0000000000000175. View

Holmes J, Lillis K, Monroe D, Borgialli D, Kerrey B, Mahajan P . Identifying children at very low risk of clinically important blunt abdominal injuries. Ann Emerg Med. 2013; 62(2):107-116.e2. DOI: 10.1016/j.annemergmed.2012.11.009. View

10.

Brenner D, Elliston C, Hall E, BERDON W . Estimated risks of radiation-induced fatal cancer from pediatric CT. AJR Am J Roentgenol. 2001; 176(2):289-96. DOI: 10.2214/ajr.176.2.1760289. View

11.

Miglioretti D, Johnson E, Williams A, Greenlee R, Weinmann S, Solberg L . The use of computed tomography in pediatrics and the associated radiation exposure and estimated cancer risk. JAMA Pediatr. 2013; 167(8):700-7. PMC: 3936795. DOI: 10.1001/jamapediatrics.2013.311. View

12.

Kim P, Zhu X, Houseknecht E, Nickolaus D, Mahboubi S, Nance M . Effective radiation dose from radiologic studies in pediatric trauma patients. World J Surg. 2005; 29(12):1557-62. DOI: 10.1007/s00268-005-0106-x. View

13.

Lee W, Parks N, Garcia A, Palmer B, Liu T, Victorino G . Pan computed tomography versus selective computed tomography in stable, young adults after blunt trauma with moderate mechanism: a cost-utility analysis. J Trauma Acute Care Surg. 2014; 77(4):527-33. DOI: 10.1097/TA.0000000000000416. View

14.

Roberts G, Jacobson L, Amaral M, Jensen C, Cooke L, Schultz J . Cross-sectional imaging of the torso reveals occult injuries in asymptomatic blunt trauma patients. World J Emerg Surg. 2020; 15:5. PMC: 6953148. DOI: 10.1186/s13017-019-0287-5. View

15.

Caputo N, Stahmer C, Lim G, Shah K . Whole-body computed tomographic scanning leads to better survival as opposed to selective scanning in trauma patients: a systematic review and meta-analysis. J Trauma Acute Care Surg. 2014; 77(4):534-9. DOI: 10.1097/TA.0000000000000414. View

16.

Chatoorgoon K, Huezo K, Rangel E, Francois N, Schweer L, Daugherty M . Unnecessary imaging, not hospital distance, or transportation mode impacts delays in the transfer of injured children. Pediatr Emerg Care. 2010; 26(7):481-6. DOI: 10.1097/PEC.0b013e3181e5bef3. View

17.

Lee C, Bernard A, Fryman L, Coughenour J, Costich J, Boulanger B . Imaging may delay transfer of rural trauma victims: a survey of referring physicians. J Trauma. 2008; 65(6):1359-63. DOI: 10.1097/TA.0b013e31818c10fc. View

18.

Odia O, Yorkgitis B, Gurien L, Hendry P, Crandall M, Skarupa D . An evidence-based algorithm decreases computed tomography use in hemodynamically stable pediatric blunt abdominal trauma patients. Am J Surg. 2020; 220(2):482-488. DOI: 10.1016/j.amjsurg.2020.01.006. View

19.

Santana J, Martinie R, Gomez J . Improving Concussion Management by Including Driving Recommendations for Adolescents with Concussions: A Quality Improvement Project. Pediatr Qual Saf. 2020; 5(3):e307. PMC: 7297390. DOI: 10.1097/pq9.0000000000000307. View