Evaluation of an evidence-based guideline to reduce CT use in the assessment of blunt pediatric abdominal trauma
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In brief
In brief
A Level I pediatric trauma center successfully reduced CT scan utilization in blunt abdominal trauma patients from 48.3% to 36.7% by implementing an evidence-based guideline using standardized criteria (mental status, abdominal exam, lab values). The guideline maintained diagnostic accuracy with no missed injuries while decreasing unnecessary radiation exposure in children.
Written by the GCMD Library team from the article.
Abstract
Purpose
About half of pediatric blunt trauma patients undergo an abdominopelvic computed tomographic (CT) scan, while few of these require intervention for an intraabdominal injury. We evaluated the effectiveness of an evidence-based guideline for blunt abdominal trauma at a Level I pediatric trauma center.
Methods
Pediatric blunt trauma patients (n = 998) age 0–15 years who presented from the injury scene were evaluated over a 10 year period. After five years, we implemented our guideline in which the decision for CT was standardized based on mental status, abdominal examination, and laboratory results (alanine aminotransferase, aspartate aminotransferase, hemoglobin, urinalysis).
Results
There were no differences in age, GCS, SIPA or ISS scores between the patients before or after guideline implementation. Nearly half of the patients (48.3%) underwent CT scan before guideline implementation compared to 36.7% after (p < 0.0002). There was no difference in ISS (p = 0.44) between CT scanned patients in either group. No statistical differences were found in rate of intervention (p = 0.20), length of stay (p = 0.65), or readmission rate (0.2%) before versus after guideline implementation. There were no missed injuries.
Conclusion
Implementation of an evidence-based clinical guideline for pediatric patients with blunt abdominal trauma decreases the rate of CT utilization while accurately identifying significant injuries.
Level of evidence
III.