Study seeks to develop rules for safer use of CT scanning on children with intra-abdominal injuries
James F. Holmes, associate professor of emergency medicine at UC Davis Health System, has received a three-year, $1.3 million grant to develop criteria for determining when computed tomography (CT) should be used on children with intra-abdominal injuries.
The study aims to generate clinical guidelines for identifying children at high risk and near-zero risk of intra-abdominal injuries in need of acute intervention. These guidelines are intended to achieve safer and more efficient and effective use of abdominal CT in children at risk for intra-abdominal injuries.
Among the conditions that would require immediate treatment are bleeding from an injured abdominal organ, such as the spleen or liver, or injuries to the gastrointestinal tract or pancreas. The latter set of injuries often requires surgery even when there are no signs of bleeding.
“In our emergency department at UC Davis Medical Center, the most common causes of intra-abdominal injuries are motor-vehicle collisions, automobiles striking pedestrians and bicyclists, and falls,” said Holmes.
— James Holmes, associate professor of emergency medicine
Although CT is the standard for diagnosing intra-abdominal injuries, the procedure has serious risks, primarily that of developing radiation-induced cancer. For every 1,500 children who undergo abdominal CT scanning, approximately one child will die from a cancer caused by the radiation, and up to three additional children will develop non-fatal cancers from the exposure. Less than 10 percent of the abdominal CT scans currently performed on children with trauma show intra-abdominal injuries.
“Emergency department physicians also use ultrasound to diagnose intra-abdominal injuries, but this method is not nearly as good as a CT scan,” Holmes said. “Ultrasound does not identify which organ is injured. It just indicates whether there is blood in the abdominal cavity.”
The objective of the study is to develop highly sensitive, specific and generalizable rules for the use of CT scanning in evaluating children with blunt abdominal trauma seen in emergency departments. These rules may then be used to generate evidence-driven guidelines for the evaluation of these children. When implemented, the guidelines will result in a more efficient use of CT scans on children at risk for intra-abdominal injuries, and a decrease in use on children with near-zero risk for those injuries.
The grant was awarded by the Centers for Disease Control and Prevention and will be conducted within the Pediatric Emergency Care Applied Research Network (PECARN), the first federally funded pediatric emergency medicine research network. Created by the federal Health Resources and Services Administration, PECARN consists of 20 emergency departments around the nation that conduct high-priority, multi-institutional research into the prevention and management of acute illnesses and injuries in children and youth of all ages.
The study will enroll children with blunt abdominal trauma seen at 17 of the PECARN hospitals over a two-year period. The emergency departments of the PECARN hospitals annually evaluate more than 900,000 children of diverse geographic and racial/ethnic backgrounds. The study will enroll 9,774 children with significant blunt torso trauma, including 900 with intra-abdominal injuries.
The primary outcome sought by the study is a set of rules for identifying intra-abdominal injuries in need of acute intervention. To do so, the researchers will analyze the patients' histories, physical examination findings and laboratory results.