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. 2020 Jun;23(3):181-184.
doi: 10.1016/j.cjtee.2019.09.002. Epub 2019 Nov 30.

Is computed tomography cystography indicated in children with pelvic fractures?

Alexander Becker  1 , Ori Yaslowitz  2 , Joseph Dubose  3 , Kobi Peleg  4 , Yaakov Daskal  5 , Adi Givon  6 ; Israel Trauma Group  7 ; Boris Kessel  8
Collaborators, Affiliations

Is computed tomography cystography indicated in children with pelvic fractures?

Alexander Becker et al. Chin J Traumatol. 2020 Jun.

Abstract

Purpose: Pelvic fracture evaluation with abdominopelvic computed tomography (CT) and formal CT cystography for rule out of urine bladder injury have been commonly employed in pediatric trauma patients. The additional delayed imaging required to obtain optimal CT cystography is, however, associated with increased doses of ionizing radiation to pelvic organs and represent a significant risk in the pediatric population for future carcinogenic risk. We hypothesized that avoidance of routine CT cystography among pediatric pelvic fracture victims would not result in an appreciable rate of missed bladder injuries and would aid in mitigating the radiation exposure risk associated with these additional images.

Methods: A retrospective cohort study involving blunt trauma pelvic fractures among pediatric trauma patients (age<14) between the years 1997 and 2016 was conducted utilizing the Israeli National Trauma Registry. Statistical analysis was performed using SAS statistical software version 9.4 via the tests of Chi-square test and two-sided Fisher's exact test. A p value of less than 0.05 was considered statistically significant.

Results: A total of 1072 children were identified from the registry for inclusion. Mean age of patients was 7.7 years (range 0-14) and 713 (66.5%) were male. Overall mortality in this population was 4.1% (44/1072). Only 2.1% (23) of pediatric patients with pelvic fractures had bladder injury identified, with just 9 children having intraperitoneal bladder rupture (0.8% of all the patients).

Conclusion: The vast majority of blunt pediatric trauma victims with pelvic fractures do not have urine bladder injuries. Based on our study results we do not recommend the routine utilization of CT cystography in this unique population.

Keywords: Bladder injury; Child; Cystography; Pelvic fracture; Tomography, X-ray computed.

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Figures

Fig. 1
Fig. 1
The distribution of ISS, GCS and AIS of pelvic fractures. ISS: injury severity score; GCS: Glasgow coma scale; AIS: abbreviated injury scale.
Fig. 2
Fig. 2
The distribution of PF by site based on ICD9.
See this image and copyright information in PMC

References

    1. Chotai N., Alazzawi S., Zehra S.S. Paediatric pelvic fractures: a review of 2 cohorts over 22 years. Injury. 2018;49:613–617. doi: 10.1016/j.injury.2018.02.005. - DOI - PubMed
    1. Rehm C.G., Mure A.J., O'Malley K.F. Blunt traumatic bladder rupture: the role of retrograde cystogram. Ann Emerg Med. 1991;20:845–847. doi: 10.1016/S0196-0644(05)81424-6. - DOI - PubMed
    1. Matlock K.A., Tyroch A.H., Kronfol Z.N. Blunt traumatic bladder rupture: a 10-year perspective. Am Surg. 2013;79:589–593. - PubMed
    1. Stein D.M., Santucci R.A. An update on urotrauma. Curr Opin Urol. 2015;25:323–330. doi: 10.1097/MOU.0000000000000184. - DOI - PubMed
    1. Myers J.B., Taylor M.B., Brant W.O. Process improvement in trauma: traumatic bladder injuries and compliance with recommended imaging evaluation. J Trauma Acute Care Surg. 2013;74:264–269. doi: 10.1097/TA.0b013e318270df2b. - DOI - PubMed