Computed tomographic imaging in the pediatric patient with a seatbelt sign: still not good enough.

Autor: Kopelman TR; Division of Burns, Trauma, and Surgical Critical Care, and Department of Surgery, Maricopa Medical Center, 2601 E Roosevelt St, Phoenix, AZ 85008. Electronic address: Tammy_Kopelman@dmgaz.org., Jamshidi R; Division of Burns, Trauma, and Surgical Critical Care, and Department of Surgery, Maricopa Medical Center, 2601 E Roosevelt St, Phoenix, AZ 85008. Electronic address: rjamshidi@phoenixchildrens.com., Pieri PG; Division of Burns, Trauma, and Surgical Critical Care, and Department of Surgery, Maricopa Medical Center, 2601 E Roosevelt St, Phoenix, AZ 85008. Electronic address: paola_pieri@dmgaz.org., Davis K; Division of Burns, Trauma, and Surgical Critical Care, and Department of Surgery, Maricopa Medical Center, 2601 E Roosevelt St, Phoenix, AZ 85008. Electronic address: karole_davis@dmgaz.org., Bogert J; Division of Burns, Trauma, and Surgical Critical Care, and Department of Surgery, Maricopa Medical Center, 2601 E Roosevelt St, Phoenix, AZ 85008. Electronic address: james.bogert@gmail.com., Vail SJ; Division of Burns, Trauma, and Surgical Critical Care, and Department of Surgery, Maricopa Medical Center, 2601 E Roosevelt St, Phoenix, AZ 85008. Electronic address: Sydney_Vail@dmgaz.org., Gridley D; Department of Radiology, Maricopa Medical Center, 2601 E Roosevelt St, Phoenix, AZ 85008. Electronic address: daniel_gridley@dmgaz.org., Singer Pressman MA; Division of Burns, Trauma, and Surgical Critical Care, and Department of Surgery, Maricopa Medical Center, 2601 E Roosevelt St, Phoenix, AZ 85008. Electronic address: Melissa_Pressman@dmgaz.org.
Jazyk: angličtina
Zdroj: Journal of pediatric surgery [J Pediatr Surg] 2018 Feb; Vol. 53 (2), pp. 357-361. Date of Electronic Publication: 2017 Oct 07.
DOI: 10.1016/j.jpedsurg.2017.10.003
Abstrakt: Purpose: Considering the improvements in CT over the past decade, this study aimed to determine whether CT can diagnose HVI in pediatric trauma patients with seatbelt signs (SBS).
Methods: We retrospectively identified pediatric patients with SBS who had abdominopelvic CT performed on initial evaluation over 5 1/2years. Abnormal CT was defined by identification of any intra-abdominal abnormality possibly related to trauma.
Results: One hundred twenty patients met inclusion criteria. CT was abnormal in 38/120 (32%) patients: 34 scans had evidence of HVI and 6 showed solid organ injury (SOI). Of the 34 with suspicion for HVI, 15 (44%) had small amounts of isolated pelvic free fluid as the only abnormal CT finding; none required intervention. Ultimately, 16/120 (13%) patients suffered HVI and underwent celiotomy. Three patients initially had a normal CT but required celiotomy for clinical deterioration within 20h of presentation. False negative CT rate was 3.6%. The sensitivity, specificity and accuracy of CT to diagnose significant HVI in the presence of SBS were 81%, 80%, and 80%, respectively.
Conclusions: Despite improvements in CT, pediatric patients with SBS may have HVI not evident on initial CT confirming the need to observation for delayed manifestation of HVI.
Level of Evidence: Level II Study of a Diagnostic Test.
(Copyright © 2017 Elsevier Inc. All rights reserved.)
Databáze: MEDLINE