Prediction rule limits CT use in children

A new prediction rule helps doctors decide when to use computed tomography (CT) scans in children with blunt trauma to the torso. The findings will enable emergency department (ED) physicians to avoid exposing children with abdominal injuries to unnecessary radiation.

Investigators from the University of California, Davis enrolled 12,000 children (median age, 11.1 years) who arrived at 20 EDs in the Pediatric Emergency Care Applied Research Network (PECARN) with injuries from vehicle accidents, falls, or assaults to participate in the study. Children were evaluated for evidence of abdominal wall trauma, a Glasgow Coma Scale score of less than 14, abdominal tenderness, thoracic wall trauma, abdominal pain, decreased breath sounds, and vomiting, in that order.

Children who displayed none of the 7 factors had only a 0.1% chance of having an abdominal injury that required acute intervention, and for most of these cases, a CT scan would not have provided additional useful information. Furthermore, the risk for future cancers caused by unnecessary radiation exposure during a CT scan when the 7 factors were missing would outweigh the risk of having a medical problem from the injury.

The researchers emphasize that having 1 of the 7 factors present does not mandate a CT scan and that sound clinical judgment is needed on a case-by-case basis. They suggest using other measures such as longer observation in the ED and ultrasonography and laboratory tests to help guide decisions for treatment in cases of abdominal trauma.