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Why do Children at Very Low Risk of Intra-Abdominal Injury (IAI) after Blunt Abdominal Trauma get Abdominal CT Scans
Pranit N. Chotai, MD1; Kyle Van Arendonk, MD, PhD2; Christian Streck, MD3; Melvin Dassinger, MD4; Adam Vogel, MD5; Robert Russell, MD, MPH6; Eunice Huang, MD, MS7; Matthew Santore, MD8; Kuojen Tsao, MD9; Richard Falcone, MD10; Jeffrey Haynes, MD11; Bindi Naik-Mathuria, MD5; Shawn St. Peter, MD12; Jeffrey S. Upperman, MD13; Claudia Pedroza, PhD14; Martin Blakely, MD2
1Vanderbilt University Medical Center, Nashville, TN; 2Monroe Carrell Jr Children's Hospital, Vanderbilt University Medical Center, Nashville, TN; 3Medical University of South Carolina, Charleston, SC; 4University of Arkansas for Medical Sciences, Little Rock, AR; 5Baylor College of Medicine, Texas Children's Hospital, Houston, TX; 6Children's of Alabama, University of Alabama, Birmingham, AL; 7Le Bonheur Children's Hospital, University of Tennessee Health Science Center, Memphis, TN; 8Emory University School of Medicine, Atlanta, GA; 9McGovern Medical School, University of Texas Health Sciences Center, Houston, TX; 10University of Cincinnati, Cincinnati, OH; 11Children's Hospital of Richmond, VCU, Richmond, VA; 12Children's Mercy Hospital, Kansas City, MO; 13Children's Hospital of Los Angeles, Keck School of Medicine of the University of Southern California, Los Angeles, CA; 14The University of Texas Health Science Center at Houston, Houston, TX

Background: A recent prospective multicenter cohort study of 2188 children with blunt abdominal trauma (BAT) found that children with no abdominal pain, normal abdominal exam, chest radiograph, and pancreatic enzymes; and AST <200U/L, had 0.6% risk of IAI. Many of these children had an abdominal CT scan. Our objectives were to identify patient factors associated with CT use and determine impact of site after adjusting for patient differences.

Methods: This is a secondary analysis of prospectively collected data from 13 centers, restricted to the very low risk population (n=373). A Bayesian lasso logistic regression model including 14 predictor variables and site was constructed. Eight variables were identified as independent predictors of CT use.

Results: Abdominal CT was obtained in 69 very low risk patients (18%). The 8 variables associated with abdominal CT usage were: thoracic spine injury, ISS 16-24, femur fracture, GCS < 12, ejection during MVC, traumatic brain injury, intubation in trauma bay, and Level 1 trauma activation. After adjusting for patient factors, site was an important predictor of CT use, the probability of abdominal CT use ranged from 2-84% (Figure).

Conclusions: In children with very low risk of IAI after BAT, abdominal CT is commonly used. After adjusting for patient differences, abdominal CT usage varies widely among sites and represents an opportunity for improvement by reducing abdominal CT usage in low risk population.


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