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Abdominal Computed Tomography in Pediatric Blunt Trauma: The Significance of Isolated Free Fluid
Preetam Gongidi DO, MHS1, Jared Meshekow MD, MPH2, Thomas Presenza DO2, Joshua Hazelton DO2, John Gaughan PhD2, Nicole Fox MD, MPH2, Emily Scattergood MD2. 1Children's Hospital of Philadelphia (CHOP), Philadelphia, PA, USA, 2Affiliated with Cooper University Hospital, Camden, New Jersey, USA.

Computed tomography of the abdomen and pelvis (CTAP) is widely used for the identification of intraabdominal injury in the trauma patient. Incidental finding of free fluid in absence of identifiable injury, referred to as isolated free fluid (IFF), may create a clinical dilemma in the pediatric blunt trauma patient. We hypothesize that the presence of IFF does not require further workup and should not mandate additional care. A retrospective review of all pediatric trauma patients ≤18yrs with a blunt mechanism of injury who received a CTAP (2011-2015, n=671) was performed. We defined IFF as simple free fluid with Hounsfield units of <20 along with the absence of identifiable injury in the abdomen and pelvis. Attending radiologist reports, age, gender, ISS, mechanism of injury, and clinical outcomes were analyzed using univariate Chi-square test. A p<0.05 was considered significant. A total 671 patients ≤18years with a blunt mechanism of injury had a CTAP performed on admission to the trauma service. We found 120 (17.9%) patients had IFF as the only positive finding on CTAP scan. Females were more than twice as likely to have IFF than their male counterparts (29% v. 13%, p<.001). Age and trauma ISS were not statistically significant (all p>0.05). No patients with IFF on CTAP developed intraabdominal pathology or required operative management of the abdomen. The presence of IFF on CTAP in the pediatric trauma patient with blunt mechanism is not associated with any injuries that require operative management and should not mandate additional clinical care.


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