Computed tomography in the management of blunt abdominal trauma in children
Sixteen children with suspected abdominal injury were reviewed. All underwent plain abdominal radiograph,y and computed tomography ( C T ) . Fifteen C T scans showed an abnormality, und the abdominal radiograph was abnormal in seven cases. Eight patients also underwent abdominal ultrasonography, and six scans failed to demonstrate an abnormality. Only two patients required laparotomy, one for a ruptured left diaphragm and one,for a major renal injury. These results support the use of C T as the optimal method f o r assessing the stable child following blunt abdominal trauma.
Immediate laparotomy is required for children with abdominal injury who remain unstable in spite of efforts to correct hypovolaemia' . However, current paediatric surgical practice is to avoid laparotomy in patients who are stable unless there are specific indications for operation. It is important, therefore, to establish the presence and nature of any intra-abdominal injury accurately and rapidly by non-surgical means.
Children with abdominal trauma present in one of three broad categories: those with clinical evidence of an abdominal injury; those who are unconscious and have a high risk of abdominal trauma; and those who are shocked on presentation with no obvious cause for the
The key to recognizing abdominal trauma is repeated clinical assessment, but this will not identify the nature of the injury. The Advanced Trauma Life Support ( ATLS) system advocates diagnostic peritoneal lavage', but this has significant drawbacks, especially in ~h i l d r e n ~-~.
Abdominal ultrasonography has a high falsenegative rate in blunt abdominal trauma7.
An extensive review from the Children's National Medical Center, Washington, DC, has confirmed the efficacy of computed tomography ( C T ) for assessing the abdomen in the multiply injured child'. Because no such data have been published from a major paediatric surgical centre in the UK, the present study was undertaken to review experience with CT in the management of blunt paediatric trauma.