title: Use of Oral Contrast for Abdominal Computed Tomography in Children With Blunt Torso Trauma.
abstract: OBJECTIVE
  We compare test characteristics of abdominal computed tomography (CT) with and without oral contrast for identifying intra-abdominal injuries.
  
  
  METHODS
  This was a planned subanalysis of a prospective, multicenter study of children (<18 years) with blunt torso trauma. Children imaged in the emergency department with abdominal CT using intravenous contrast were eligible. Oral contrast use was based on the participating centers' guidelines and discretions. Clinical courses were followed to identify patients with intra-abdominal injuries. Abdominal CTs were considered positive for intra-abdominal injury if a specific intra-abdominal injury was identified and considered abnormal if any findings suggestive of intra-abdominal injury were identified on the CT.
  
  
  RESULTS
  A total of 12,044 patients were enrolled, with 5,276 undergoing abdominal CT with intravenous contrast. Of the 4,987 CTs (95%) with documented use or nonuse of oral contrast, 1,010 (20%) were with and 3,977 (80%) were without oral contrast; 686 patients (14%) had intra-abdominal injuries, including 127 CTs (19%) with and 559 (81%) without oral contrast. The sensitivity in the detection of any intra-abdominal injury in the oral contrast versus no oral contrast groups was sensitivitycontrast 99.2% (95% confidence interval [CI] 95.7% to 100.0%) versus sensitivityno contrast 97.7% (95% CI 96.1% to 98.8%), difference 1.5% (95% CI -0.4% to 3.5%). The specificity of the oral contrast versus no oral contrast groups was specificitycontrast 84.7% (95% CI 82.2% to 87.0%) versus specificityno contrast 80.8% (95% CI 79.4% to 82.1%), difference 4.0% (95% CI 1.3% to 6.7%).
  
  
  CONCLUSIONS
  Oral contrast is still used in a substantial portion of children undergoing abdominal CT after blunt torso trauma. With the exception of a slightly better specificity, test characteristics for detecting intra-abdominal injury were similar between CT with and without oral contrast.
authors: Department of Pediatrics, Perelman School of Medicine/Children's Hospital of Philadelphia, Philadelphia, PA. Electronic address: ellisona@email.chop.edu.
authors: Angela M
authors: AM
authors: Ellison
authors: Department of Pediatrics, Washington University/St. Louis Children's Hospital, St. Louis, MO.
authors: Kimberly S
authors: KS
authors: Quayle
authors: Department of Pediatrics, Rady Children's Hospital.
authors: Bema
authors: B
authors: Bonsu
authors: Department of Emergency Medicine, University of Rochester, Rochester, NY.
authors: Madelyn
authors: M
authors: Garcia
authors: Department of Pediatrics, Albert Einstein College of Medicine, Bronx, NY.
authors: Stephen
authors: S
authors: Blumberg
authors: Department of Emergency Medicine, University of Michigan, Ann Arbor, MI.
authors: Alexander
authors: A
authors: Rogers
authors: Department of Radiology, University of California, Davis School of Medicine, Sacramento, CA.
authors: Sandra L
authors: SL
authors: Wootton-Gorges
authors: Division of Emergency Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH.
authors: Benjamin T
authors: BT
authors: Kerrey
authors: Department of Pediatrics, University of Utah and PECARN Data Coordinating Center, Salt Lake City, UT.
authors: Lawrence J
authors: LJ
authors: Cook
authors: Department of Surgery, College of Physicians and Surgeons, New York, NY.
authors: Arthur
authors: A
authors: Cooper
authors: Department of Emergency Medicine, University of California, Davis School of Medicine, Sacramento, CA; Department of Pediatrics, University of California, Davis School of Medicine, Sacramento, CA.
authors: Nathan
authors: N
authors: Kuppermann
authors: Department of Emergency Medicine, University of California, Davis School of Medicine, Sacramento, CA.
authors: James F
authors: JF
authors: Holmes
mesh_terms: D000007:Abdominal Injuries / Q000000981:diagnostic imaging*; D061605:Administration, Intravenous; D000284:Administration, Oral; D000293:Adolescent; D002648:Child; D003287:Contrast Media / Q000009:adverse effects*; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D008297:Male; D011446:Prospective Studies; D011860:Radiography, Abdominal / Q000379:methods*; D014057:Tomography, X-Ray Computed / Q000379:methods*; D016896:Treatment Outcome; D014949:Wounds, Nonpenetrating / Q000000981:diagnostic imaging*
chemical_list: D003287:Contrast Media