Effect of CT information on the diagnosis and management of acute abdominal injury in children.

Abstract

To evaluate the effect of computed tomographic (CT) information on diagnostic confidence and initial clinical treatment in children with abdominal trauma. Senior surgical staff completed questionnaires before and after abdominal CT was performed in 138 consecutive children with acute abdominal trauma seen between April 1996 and April 1997. Physicians were asked to estimate the probability of underlying abdominal injury, which organ was injured, their level of confidence in the CT findings, and initial clinical management plans. The gain in percentage diagnostic confidence and the proportion of children in whom CT information changed diagnoses and initial management plans were evaluated. The CT findings changed the surgeons' initial diagnoses in 116 (84%) patients (95% confidence interval [CI] = 75%, 86%). The mean gain in diagnostic certainty with CT was 36% (95% CI = 31%, 40%). Initial management plans changed in 61 (44%) patients after CT information was available (95% CI = 35%, 50%). This resulted in decreased intensity of care in 52 (38%) patients and increased intensity of care in nine (6.5%). Abdominal CT had a strong effect on surgeons' clinical diagnoses and initial treatment plans in children with blunt trauma. CT information enabled surgeons to safely reduce the intensity of care provided to injured children.