Professor Children's Hospital Colorado/ University of Colorado School of Medicine Aurora, Colorado, United States
Background: Computed tomography (CT) with intravenous (IV) contrast is a highly sensitive tool for diagnosis of injury following blunt abdominal trauma in pediatric patients. However, the prevalence of clinically important intra-abdominal injury (ci-IAI) is less than 5%; and CT imaging may not change management for many children since most pediatric intra-abdominal injuries do not require operative or procedural intervention. Ionizing radiation from CT is also associated with potential harms to children. Objective: To use the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) methodology to perform a systematic review and meta-analysis to generate evidence-based recommendations regarding the utility of laboratory tests, FAST, and abdominal seat belt sign as compared to CT abdomen and pelvis with intravenous (IV) contrast to evaluate for clinically important intra-abdominal injuries. Design/Methods: Three relevant questions related to imaging after abdominal trauma in pediatric patients were developed using clearly defined Population (P), Intervention (I), Comparison (C), and appropriately selected Outcomes (O) (PICO). The questions focused on using laboratory tests, Focused Assessment with Sonography for Trauma (FAST), and the presence of an abdominal seatbelt sign to evaluate for ci-IAI as compared to CT as the gold standard. A systematic review and meta-analysis was conducted using the GRADE methodology. The multi-specialty (emergency medicine, surgery, radiology) working group reached consensus on the final evidence-based recommendations. Results: A total of 5141 articles were screened, and data from 26 studies were included in the meta-analysis. Most of the studies were retrospective (69.2%), and the quality of the available evidence was determined to be very low.
Conclusion(s): In hemodynamically normal pediatric patients ( < 18 years) with blunt abdominal trauma without signs of peritonitis: (1) We cannot make any recommendation regarding use of laboratory tests versus CT abdomen and pelvis with IV contrast to identify ci-IAI. (2) We conditionally recommend against using FAST to identify ci-IAI. No recommendation could be made on the use of FAST to determine the need for further imaging. (3) We conditionally recommend CT abdomen and pelvis with IV contrast to identify ci-IAI in pediatric patients with an abdominal seatbelt sign.
