Computed tomographic imaging in the pediatric patient with a seatbelt sign: still not good enough

Tammy R Kopelman; Ramin Jamshidi; Paola G Pieri; Karole Davis; James Bogert; Sydney J Vail; Daniel Gridley; Melissa A Singer Pressman

doi:10.1016/j.jpedsurg.2017.10.003

Computed tomographic imaging in the pediatric patient with a seatbelt sign: still not good enough

J Pediatr Surg. 2018 Feb;53(2):357-361. doi: 10.1016/j.jpedsurg.2017.10.003. Epub 2017 Oct 7.

Authors

Tammy R Kopelman¹, Ramin Jamshidi², Paola G Pieri³, Karole Davis⁴, James Bogert⁵, Sydney J Vail⁶, Daniel Gridley⁷, Melissa A Singer Pressman⁸

Affiliations

¹ Division of Burns, Trauma, and Surgical Critical Care, and Department of Surgery, Maricopa Medical Center, 2601 E Roosevelt St, Phoenix, AZ 85008. Electronic address: Tammy_Kopelman@dmgaz.org.
² Division of Burns, Trauma, and Surgical Critical Care, and Department of Surgery, Maricopa Medical Center, 2601 E Roosevelt St, Phoenix, AZ 85008. Electronic address: rjamshidi@phoenixchildrens.com.
³ Division of Burns, Trauma, and Surgical Critical Care, and Department of Surgery, Maricopa Medical Center, 2601 E Roosevelt St, Phoenix, AZ 85008. Electronic address: paola_pieri@dmgaz.org.
⁴ Division of Burns, Trauma, and Surgical Critical Care, and Department of Surgery, Maricopa Medical Center, 2601 E Roosevelt St, Phoenix, AZ 85008. Electronic address: karole_davis@dmgaz.org.
⁵ Division of Burns, Trauma, and Surgical Critical Care, and Department of Surgery, Maricopa Medical Center, 2601 E Roosevelt St, Phoenix, AZ 85008. Electronic address: james.bogert@gmail.com.
⁶ Division of Burns, Trauma, and Surgical Critical Care, and Department of Surgery, Maricopa Medical Center, 2601 E Roosevelt St, Phoenix, AZ 85008. Electronic address: Sydney_Vail@dmgaz.org.
⁷ Department of Radiology, Maricopa Medical Center, 2601 E Roosevelt St, Phoenix, AZ 85008. Electronic address: daniel_gridley@dmgaz.org.
⁸ Division of Burns, Trauma, and Surgical Critical Care, and Department of Surgery, Maricopa Medical Center, 2601 E Roosevelt St, Phoenix, AZ 85008. Electronic address: Melissa_Pressman@dmgaz.org.

PMID: 29198896
DOI: 10.1016/j.jpedsurg.2017.10.003

Abstract

Purpose: Considering the improvements in CT over the past decade, this study aimed to determine whether CT can diagnose HVI in pediatric trauma patients with seatbelt signs (SBS).

Methods: We retrospectively identified pediatric patients with SBS who had abdominopelvic CT performed on initial evaluation over 5 1/2years. Abnormal CT was defined by identification of any intra-abdominal abnormality possibly related to trauma.

Results: One hundred twenty patients met inclusion criteria. CT was abnormal 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, 15 (44%) had small amounts of isolated pelvic free fluid as the only abnormal CT finding; none required intervention. Ultimately, 16/120 (13%) patients suffered HVI and underwent celiotomy. Three patients initially had a normal CT but required celiotomy for clinical deterioration within 20h of presentation. False negative CT rate was 3.6%. The sensitivity, specificity and accuracy of CT to diagnose significant HVI in the presence of SBS were 81%, 80%, and 80%, respectively.

Conclusions: Despite improvements in CT, pediatric patients with SBS may have HVI not evident on initial CT confirming the need to observation for delayed manifestation of HVI.

Level of evidence: Level II Study of a Diagnostic Test.

Keywords: Computed tomography; Pediatrics; Seatbelt sign.

MeSH terms

Abdominal Injuries / diagnostic imaging*
Abdominal Injuries / etiology
Accidents, Traffic*
Adolescent
Child
Child, Preschool
Female
Humans
Male
Retrospective Studies
Sensitivity and Specificity
Tomography, X-Ray Computed*
Wounds, Nonpenetrating / diagnostic imaging*
Wounds, Nonpenetrating / etiology