title: When is it safe to forgo abdominal CT in blunt-injured children?
abstract: BACKGROUND
  CT is the standard modality to diagnose solid organ injury after blunt trauma; however, the associated radiation carries a risk of cancer. We hypothesized that there are patient-specific factors that can identify those children who require abdominal CT.
  
  
  METHODS
  We reviewed all children admitted to 2 pediatric trauma centers after blunt trauma with liver or spleen injury from January 2009 to December 2013. The low-risk group was defined as a Glasgow Coma Scale (GCS) of 15 with normal pediatric age-adjusted shock index (heart rate/systolic blood pressure; SIPA) on presentation, and injury attributable to a single, nonmotorized, blunt force to the abdomen. The at-risk group did not meet these criteria.
  
  
  RESULTS
  We identified 206 children with blunt liver or spleen injury, 101 of whom met the low-risk criteria. Among these 101 children who met the low-risk criteria, there were no deaths, no children required laparotomy, only 1 child required a packed red cell transfusion, and no children required discharge to a rehabilitation facility.
  
  
  CONCLUSIONS
  Children who present to the emergency department after blunt abdominal trauma by a nonmotorized force with a normal GCS and SIPA are unlikely to have a solid organ injury that will require intervention.
authors.affiliation: Department of Pediatric Surgery, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, CO. Electronic address: shannon.acker@ucdenver.edu.
authors.forename: Shannon N
authors.initials: SN
authors.lastname: Acker
authors.affiliation: Department of Pediatric Surgery, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, CO.
authors.forename: Camille L
authors.initials: CL
authors.lastname: Stewart
authors.affiliation: Department of Pediatric Emergency Medicine, Denver Health Medical Center, Denver, CO.
authors.forename: Genie E
authors.initials: GE
authors.lastname: Roosevelt
authors.affiliation: Department of Pediatric Surgery, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, CO.
authors.forename: David A
authors.initials: DA
authors.lastname: Partrick
authors.affiliation: Department of Surgery, Denver Health Medical Center, Denver, CO.
authors.forename: Ernest E
authors.initials: EE
authors.lastname: Moore
authors.affiliation: Department of Pediatric Surgery, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, CO; Department of Surgery, Denver Health Medical Center, Denver, CO.
authors.forename: Denis D
authors.initials: DD
authors.lastname: Bensard
mesh_terms: D000007:Abdominal Injuries / Q000000981:diagnostic imaging* / Q000209:etiology; D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003661:Decision Support Techniques; D005260:Female; D015600:Glasgow Coma Scale; D006801:Humans; D008099:Liver / Q000000981:diagnostic imaging / Q000293:injuries*; D016015:Logistic Models; D008297:Male; D012189:Retrospective Studies; D018570:Risk Assessment; D013154:Spleen / Q000000981:diagnostic imaging / Q000293:injuries*; D014057:Tomography, X-Ray Computed; D014949:Wounds, Nonpenetrating / Q000000981:diagnostic imaging* / Q000209:etiology