Js. Graham et Al. Wong, A REVIEW OF COMPUTED-TOMOGRAPHY IN THE DIAGNOSIS OF INTESTINAL AND MESENTERIC INJURY IN PEDIATRIC BLUNT ABDOMINAL-TRAUMA, Journal of pediatric surgery, 31(6), 1996, pp. 754-756
Objective: To determine the sensitivity, specificity, and positive and
negative predictive values of the computed tomography (CT) scan in th
e diagnosis of clinically significant intestinal and mesenteric injury
in pediatric blunt abdominal trauma. Patients: The records of 145 chi
ldren who presented to a tertiary care pediatric hospital between 1987
and 1994 were reviewed retrospectively. All had experienced single or
multiple injuries and underwent CT as part of the trauma assessment.
Methods: The patients were divided into two cohorts, based on the resu
lts of the initial CT scan: either positive (n = 20) or negative (n =
152) for evidence of intestinal or mesenteric injury. The two cohorts
were similar with respect to age, trauma score, and timing of CT scan.
The outcome of surgical (n = 23) and conservative management (n = 122
) was compared with the initial CT scan results. (Some of the laparoto
mies were for solid organ injury only.) Results: The sensitivity of th
e CT scan in the diagnosis of clinically significant intestinal and me
senteric injury is 0.93. The specificity and positive and negative pre
dictive values are 0.95, 0.65, and 0.99, respectively. Conclusion: The
CT scan is an excellent test to screen for clinically significant int
estinal and mesenteric injury in pediatric patients with blunt abdomin
al trauma. Because of the lower positive value, other clinical and dia
gnostic imaging information may help to improve diagnostic accuracy. M
ost importantly, CT rarely misses a significant intestinal or mesenter
ic injury. Copyright (C) 1996 by W.B. Saunders Company