Best Practice Imaging in the Initial Investigation of Paediatric Blunt Abdominal Trauma: A Narrative Review

Paediatric blunt abdominal trauma (BAT) presents a diagnostic challenge, requiring accurate identification of intra-abdominal injury (IAI) whilst minimising unnecessary radiation exposure. The aim of this study was to evaluate best practice imaging strategies for paediatric BAT, with a focus on justification of computed tomography (CT) and the role of non-ionising alternatives. A narrative review was conducted between 2014 and 2025 using eligible English-language literature indexed in Medline, Embase, Scopus, CINAHL, and Cochrane. Eligible studies reported on diagnostic imaging performance or justification in paediatric BAT. Fifty-seven studies were included. Focused Assessment with Sonography in Trauma (FAST) demonstrated low sensitivity but high specificity, limiting its ability to exclude IAI though useful when interpreted alongside clinical markers. Contrast-enhanced ultrasound (CEUS) showed promising accuracy for solid organ injury, but evidence remains limited by small, retrospective cohorts. CT remains the reference standard for excluding IAI, with the Paediatric Emergency Care Applied Research Network (PECARN) guideline emerging as the most validated clinical decision rule to guide justification and reduce unnecessary scans. Current evidence supports CT as the definitive modality, but non-ionising imaging and validated clinical rules can help minimise radiation exposure. Larger prospective multi-centre studies, particularly of CEUS and less validated decision rules, are needed to establish optimal imaging pathways and refine best practice.