Evaluation of Pediatric Patients with Blunt Abdominal Trauma: A Systematic Review, Meta-Analysis, and Practice Management Recommendations

Background Computed tomography (CT) with intravenous contrast is a highly sensitive tool for diagnosis of injury following blunt abdominal trauma. However, the prevalence of clinically important intra-abdominal injury (CIIAI) in hemodynamically normal pediatric patients is less than 2%, and CT may not change management for many children since most pediatric intra-abdominal injuries do not require operative or procedural intervention. Ionizing radiation from CT is also associated with potential harms to children. Methods Three relevant questions related to imaging after abdominal trauma in pediatric patients were developed using clearly defined Population (P), Intervention (I), Comparison (C), and appropriately selected Outcomes (O) (PICO). A systematic review and meta-analysis was conducted using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology. The multispecialty working group reached consensus on the final evidence-based recommendations. Results A total of 5141 articles were screened, and data from 13 studies were included in the meta-analysis. Most of the studies were retrospective, and the quality of the available evidence was determined to be very low. Conclusions In hemodynamically normal pediatric patients (<18 years) with blunt abdominal trauma without signs of peritonitis: (1) We cannot make any recommendation regarding use of laboratory tests versus CT abdomen and pelvis as the initial screening test to identify CIIAI. (2) We cannot make any recommendation regarding the use of Focused Assessment with Sonography for Trauma (FAST) to identify CIIAI, or on the use of FAST to determine the need for further imaging. (3) We conditionally recommend CT abdomen and pelvis to identify CIIAI in pediatric patients with an abdominal seatbelt sign.