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Prospective evaluation of an evidence-based decision tool to assess pediatric blunt abdominal trauma (BAT)

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Abstract

Purpose

Computed tomography (CT) is currently the standard for evaluation of intra-abdominal injury (IAI) after BAT. Pediatric patients receiving CT scans based on adult clinical protocols are potentially exposed to unnecessary radiation. The purpose of this study is to determine the rate of CT scans before and after implementation of a pediatric BAT decision tool.

Methods

We adapted and implemented an evidence-based decision tool for pediatric BAT based on five clinical variables. We reviewed patient charts 18 months pre- and post-implementation. Demographics and outcomes were compared using Chi-square and Fisher’s exact test, accordingly.

Results

The pre and post-implementation groups were uniform when comparing age, sex, mechanism, and Injury Severity Score. The decision tool was utilized in 85% of patients post-implementation. Fewer CT scans were obtained in the post-implementation group (28 vs. 21%, p = 0.215) with no missed injuries or late diagnoses.

Conclusion

Implementation of a pediatric BAT decision tool decreased CT usage and radiation exposure without an obvious compromise to patient care. This experience supports the utilization of these tools for the assessment of IAI after BAT and have resulted in more selective use of CT during pediatric BAT in our program.

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Acknowledgements

The authors would like to thank Dr. Christian Streck for his guidance and review of the manuscript.

Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

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Authors and Affiliations

  1. Department of Pediatric Surgery, Beaumont Health, Royal Oak, MI, USA

    Elizabeth Boudiab, Samer Kawak, Alan Tom & Diane Studzinski

  2. Section of Pediatric Surgery, Beaumont Children’s, Royal Oak, MI, USA

    Nathan Novotny, Pavan Brahmamdam & Begum Akay

  3. Oakland University William Beaumont School of Medicine, Rochester, MI, USA

    Nathan Novotny, Pavan Brahmamdam & Begum Akay

  4. Department of Pediatric Surgery, Beaumont Children’s, Oakland University William Beaumont School of Medicine, 3535 West 13 Mile Road, Suite 307, Royal Oak, MI, 48073, USA

    Begum Akay

Authors
  1. Elizabeth Boudiab
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  2. Samer Kawak
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  3. Alan Tom
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  4. Diane Studzinski
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  5. Nathan Novotny
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  6. Pavan Brahmamdam
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  7. Begum Akay
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Correspondence to Begum Akay.

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Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional research committee (Institutional Review Board, approval #2018–150) and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Our study used retrospective and prospective data available in the electronic medical record. The written authorization permitting disclosure of protected health information for research purposes, previously obtained from each patient, was utilized as consent for our use of these data. The authorization permits the use of patient medical record information, obtained in the normal course of patient care, for research purposes, such as this study, in the future. There was no direct contact with patients during the study. All patient data was de-identified following extraction from medical records, and subsequent import into a secure database, to ensure patient confidentiality.

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Boudiab, E., Kawak, S., Tom, A. et al. Prospective evaluation of an evidence-based decision tool to assess pediatric blunt abdominal trauma (BAT). Pediatr Surg Int 38, 183–191 (2022). https://doi.org/10.1007/s00383-021-05013-x

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  • DOI: https://doi.org/10.1007/s00383-021-05013-x

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