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The Importance of Tenderness in the Evaluation of Pediatric Blunt Abdominal Trauma
Lauren Gillory MD, Kausar Ali BS, Eric Rosenfeld MD, Bindi Naik-Mathuria MD. Baylor College of Medicine, Department of Surgery, Division of Pediatric Surgery, Texas Children's Hospital, Houston, TX, USA.

Background: Overuse of computed tomography (CT) is prevalent in the evaluation of pediatric blunt abdominal trauma (BAT). Our purpose was to determine whether CT could have been avoided in patients without significant abdominal tenderness.

Methods: Retrospective review of patients who had CT to evaluate BAT at a level I pediatric trauma center between 2011-2014. Data collected included degree of abdominal tenderness at presentation, CT indication and findings, abdominal operations and hospital course.

Results: There were 289 children identified (median age 8 years, range 0.4 - 17). Excluding unconscious patients, abdominal/flank tenderness was reported in 278 patients. The most common reason for obtaining CT in the no tenderness group was "mechanism" (41%). Clinically significant injuries (CSI) were most common in the moderate/severe tenderness group (OR 13.6 vs no/mild tenderness). All patients who required abdominal surgery had moderate/severe abdominal tenderness. Of the 11 patients with isolated low-grade (AAST I/II) solid organ injuries, 45% had no/mild tenderness, mean hematocrit drop was 1.3, and there were no transfusions or adverse outcomes.

Conclusions: These findings suggest that abdominal tenderness is of significant prognostic value in determining CSI in children with BAT, and avoiding CT for patients with no/mild tenderness could be considered. Although some low-grade solid organ injuries may be missed using this approach, these injuries are unlikely to cause bleeding or adverse outcomes. Larger, prospective studies are needed for validation.

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