BLUNT ABDOMINAL-TRAUMA IN CHILDREN - IMPACT OF CT ON OPERATIVE AND NONOPERATIVE MANAGEMENT

OBJECTIVE. The purpose of this study was to evaluate the impact of CT on operative management of children examined after blunt abdominal tra uma. SUBJECTS AND METHODS. Fifteen-hundred consecutive children who su stained blunt abdominal trauma were prospectively examined with CT. CT findings and the decision for operative or nonoperative management we re recorded prospectively. In the children who underwent laparotomy, i ndications for operative intervention as determined by the attending t rauma surgeon and surgical findings were also recorded. RESULTS. Three hundred eighty-eight (26%) of the CT scans had abnormal findings: sol id viscus injury, 286; other CT abnormality, 102. Twenty (7%) of 286 c hildren with a solid viscus injury and 25 (83%) of 30 children with a hollow viscus injury underwent therapeutic laparotomy. Abnormalities s een on CT were noted in all 20 children with solid viscus injury and 2 4 of 25 children with hollow viscus injury who underwent therapeutic l aparotomy. The decision for laparotomy was based on CT findings in fiv e (25%) of 20 children with solid viscus injury and 17 (68%) of 25 chi ldren with hollow viscus injury, Eleven hundred twelve children (74%) had normal findings on CT. Only one of these children later required l aparotomy. CONCLUSION. CT rarely influenced the decision for operative intervention in children who sustained blunt abdominal trauma. CT fin dings affected the decision for operative intervention in most childre n with hollow viscus injury; however, CT findings affected such a deci sion in only a small subset of children with solid viscus injury, Norm al abdominal CT findings strongly predicted a lack of subsequent deter ioration requiring operative intervention.