Abdominal CT in children with neurologic impairment following blunt trauma. Abdominal CT in comatose children

Abstract

This paper examines the role of neurologic impairment as an indication for CT examination of the abdomen in children after blunt trauma. The clinical information and abdominal CT examinations of 482 consecutive children were reviewed prospectively for indications for abdominal CT and presence and severity of abdominal and chest injury. Children were divided into two groups determined by Glasgow Coma Scale (GCS): GCS less than 8, and greater than or equal to 8. The prevalence and severity of thoracoabdominal injury were higher in the neurologically impaired group. These children had a higher frequency of abdominal injury (GCS less than 8, 25 of 90 patients (27.8%) vs. GCS greater than or equal to 8, 70 of 392 patients (17.8%); p = 0.047 by Chi square test), injury to multiple abdominal organs (16.7% vs. 4.8%; p = 0.0002), chest injury (32.2% vs. 0.09%; p = 0.0001), and combined chest and abdominal injury (18.9% vs. 4.6%; p = 0.0001). In addition, the mortality rate in children with a GCS less than 8 was significantly higher (GCS less than 8, 24% vs. GCS greater than or equal to 8, 0.26%; p = 0.0001). Eleven children had a GCS less than 8 as the only indication for abdominal CT examination. All 11 children had a normal CT of the abdomen. Every child with abdominal injury on CT scan had specific abdominal signs suggestive of underlying injury. Three neurologically impaired children required abdominal surgery (3.3%) vs. 14 of 369 (3.8%) children with a GCS greater than or equal to 8; p = NS). We conclude that children with severe neurologic impairment are at higher risk for intraabdominal injury than those without coma, but that neurologic impairment without abdominal signs is a low-yield indication for abdominal CT examination. Abdominal CT scan should be reserved for children in whom there is a high clinical index of suspicion of significant abdominal trauma based on physical examination and the mechanism of injury.