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7-Item List Proposed For Ruling Out Kids’ CT

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A new study of more than 12,000 children seen in emergency departments proposes a seven-point checklist to determine whether a child should receive a CT scan following blunt-force trauma to the abdomen.

The study determined that children having none of the seven risk factors had only a 0.1 percent chance of having an abdominal injury that would require immediate intervention. Therefore, the authors said, a CT scan in those cases is very unlikely to provide additional useful information and should be avoided in order not to expose children to unnecessary radiation.

James Holmes, MD, principal investigator and lead author of the study, said:

We have now identified a population of pediatric patients that does not typically benefit from a CT scan, which is an important step in reducing radiation exposure.

Dr. Holmes is a professor of emergency medicine at the UC Davis School of Medicine. The study involved 12,044 children in 20 emergency departments throughout the United States who had suffered blunt trauma to the abdomen. The departments were members of the Pediatric Emergency Care Applied Research Network (PECARN), a national network of pediatric emergency departments that supplies data for researchers.

The study results were published online today inĀ Annals of Emergency Medicine.

The seven risk factors are, in descending order of importance, evidence of abdominal wall trauma or a mark from a seat belt, a Glasgow Coma Scale score of 13 or lower, abdominal tenderness, evidence of thoracic wall trauma, complaints of abdominal pain, decreased breath sounds, and vomiting.

The authors pointed out that the seven-factor prediction rule was intended only to help rule out the need for CT. It does not call for a CT scan based solely on the presence of any one of the risk factors. In fact, if the rule were used that way, the number of pediatric CT scans would actually increase. The authors emphasized the importance in CT decisions of clinical judgment and, if necessary, extending the period of emergency department observation and using supplementary ultrasound imaging.

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Related seminar: Pediatric Radiology


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