An evidence-based algorithm decreases computed tomography use in hemodynamically stable pediatric blunt abdominal trauma patients.

BACKGROUND: There are concerns about overuse of abdominopelvic-computed tomography (CTAP) in pediatric blunt abdominal trauma (BAT) given malignancy risks. This study evaluates how an evidence-based algorithm affected CTAP and hospital resource use for hemodynamically stable children with BAT.

MATERIALS AND METHODS: This is a retrospective cohort study of hemodynamically stable pediatric BAT patients one year before and after algorithm implementation. We included children less than or equal to 14 years of age treated in a Level I pediatric trauma center. We compared CTAP rates before and after algorithm implementation.

RESULTS: There were 65 in the pre- and 50 in the post-algorithm implementation group, and CTAPs decreased by 27% (p = 0.02). The unadjusted and adjusted odds ratio of receiving a CTAP after algorithm implementation were 0.3 (95% CI 0.1-0.6) and 0.2 (95% CI 0.1-0.7), respectively. There were no significant missed injuries in the post cohort. ED length of stay (LOS) decreased by 53 min (p = 0.03).

CONCLUSIONS: An evidence-based algorithm safely decreased CTAPs for pediatric BAT with no increase in hospital resource utilization.