Leeper Christine M, Nasr Isam, Koff Abigail, McKenna Christine, Gaines Barbara A
Division of General Surgery and Trauma, Department of Surgery, University of Pittsburgh Medical Center. 200 Lothrop Street, Pittsburgh, PA 15213, USA; Children's Hospital of Pittsburgh of UPMC. 7th Floor, Faculty Pavilion, One Children's Hospital Drive, 4401 Penn Avenue, Pittsburgh, PA 15224, USA.
The Johns Hopkins Department of Surgery, 1800 Orleans Street Pediatric Surgery Bloomberg 7323, Baltimore, MD 2128.
J Pediatr Surg. 2018 Apr;53(4):775-779. doi: 10.1016/j.jpedsurg.2017.05.025. Epub 2017 Jun 6.
Diagnostic imaging of pediatric blunt abdominal trauma is evolving in light of increased attention to radiation exposure. We hypothesize that the implementation of imaging guidelines has reduced total CT scans without missing clinically significant injury.
We retrospectively reviewed blunt trauma patients age 0-17 with solid organ injury who underwent CT scan at our academic level 1 pediatric trauma center between 2005 and 2014. Variables including total annual trauma admissions and CT scans, demographics, injury characteristics, and procedures were recorded. Descriptive statistics, Fisher exact and rank sum testing were performed. p<0.05 defined significance.
Overall percentage of abdominal CT scans decreased significantly after protocol implementation. There were 498 solid organ injuries in 403 subjects. There was a significant decrease in the median percentage of low grade injuries (1.3% versus 0.6%; p=0.019) but no difference in high grade injuries (1.3% versus 1.1%; p=0.394). No patient had death, readmission or delayed diagnosis of injury requiring intervention.
Implementation of imaging guidelines for blunt abdominal trauma decreased the incidence of low grade solid organ injuries at our institution, but did not inhibit diagnosis and safe management of high grade injuries. Selective imaging of trauma patients decreases childhood radiation exposure and does not result in delayed bleeding or death.
Level III, retrospective study.
鉴于对辐射暴露的关注度增加，小儿钝性腹部创伤的诊断性成像技术正在不断发展。我们假设，成像指南的实施减少了CT扫描的总数，同时又不会遗漏具有临床意义的损伤。
我们回顾性分析了2005年至2014年间在我们一级学术性儿科创伤中心接受CT扫描的0至17岁钝性创伤且伴有实体器官损伤的患者。记录了包括每年创伤总入院人数和CT扫描次数、人口统计学资料、损伤特征及治疗程序等变量。进行了描述性统计、Fisher精确检验和秩和检验。p<0.05为有统计学意义。
实施方案后，腹部CT扫描的总体百分比显著下降。403名受试者中有498处实体器官损伤。低级别损伤的中位数百分比显著下降（1.3%对0.6%；p=0.019），但高级别损伤无差异（1.3%对1.1%；p=0.394）。没有患者死亡、再次入院或出现需要干预的损伤延迟诊断情况。
钝性腹部创伤成像指南的实施降低了我院低级别实体器官损伤的发生率，但并未妨碍高级别损伤的诊断和安全处理。对创伤患者进行选择性成像可减少儿童期辐射暴露，且不会导致延迟出血或死亡。
三级，回顾性研究。
