Evaluation of triphasic abdominal computed tomography in the management of pediatric blunt abdominal trauma

Introduction
Despite improvement in the management of pediatric trauma, it remains the most common cause of morbidity and mortality. Missed abdominal injuries pose a greater risk in children than in adults. Abdominal trauma assessment is challenging in the pediatric age group. Computed tomography (CT) is currently the gold standard in the identification of intraabdominal injury in blunt abdominal trauma. Being more sensitive to radiation, pediatric centers have adopted protocols with the goals of reducing radiation exposure. This study aims to evaluate the use of triphasic abdominal CT as a diagnostic tool in the management of pediatric blunt abdominal trauma.
Patients and methods
Patients under 14 years of age with blunt abdominal trauma treated in a tertiary care center over a period of 10 months were included in a prospective observational study. Rate of triphasic abdominal CT was calculated and compared with the rate of CT in clinical effectiveness guidelines according to Leeper and colleagues.
Results
Of the 107 pediatric patients presented during the study period, 96 patients were hemodynamically stable and fulfilled complete abdominal triphasic CT criteria and were included in the study. In all, 60 cases underwent CT, while 36 cases were managed without CT due to the lack of criteria needed for the decision of CT in clinical presentation, laboratory results, and FAST. Triphasic CT of the abdomen was crucial for the diagnosis and intervention for seven (11.5%) cases; three cases underwent exploration while four cases were managed by interventional radiology, whereas the rest of cases were managed nonoperatively. The number of male and female participants was 62 and 34, respectively (64.5 and 35.4%). Their ages ranged from 6 months to 13.5 years with a median age of 5 years. The mechanism of injury included falls from height (45%), automobile versus pedestrian accident (31%), and crush injury to the torso (13%). The rate of CT use in this study was compared with that of use in case of implementing clinical effectiveness guidelines were 62.5 and 72.9%, respectively.
Conclusion
Triphasic abdominal CT in properly selected patients is effective in the management of pediatric trauma without overuse.