Kopelman TR, et al. - This study was performed to assess whether CT can diagnose HVI in pediatric trauma patients with seatbelt signs (SBS). Although improvements in CT have been observed, pediatric patients with SBS could have HVI not evident on initial CT confirming the necessity for observation for delayed manifestation of HVI.

Methods

• Pediatric patients with SBS who had abdominopelvic CT performed on initial evaluation over 5 1/2 years were retrospectively identified.
• Identification of any intra-abdominal abnormality possibly related to trauma was defined as abnormal CT.

Results

• Inclusion criteria was met by 120 patients.
• Abnormal CT was observed in 38/120 (32%) patients: 34 scans had evidence of HVI and 6 showed solid organ injury (SOI).
• Of the 34 with suspicion for HVI, small amounts of isolated pelvic free fluid was identified in 15 (44%) patients as the only abnormal CT finding; none of these required intervention.
• Ultimately, in 16/120 (13%) patients, HVI was identified and celiotomy was performed.
• Researchers identified 3 patients with an initial normal CT who underwent celiotomy for clinical deterioration within 20 h of presentation.
• In this study, false negative CT rate was 3.6%.
• To diagnose significant HVI in the presence of SBS, CT had the sensitivity, specificity and accuracy of 81%, 80%, and 80%, respectively.