A review of computed tomography in the diagnosis of intestinal and mesenteric injury in pediatric blunt abdominal trauma

Objective: To determine the sensitivity, specificity, and positive and negative predictive values of the computed tomography (CT) scan in the diagnosis of clinically significant intestinal and mesenteric injury in pediatric blunt abdominal trauma. Patients: The records of 145 children who presented to a tertiary care pediatric hospital between 1987 and 1994 were reviewed retrospectively. All had experienced single or multiple injuries and underwent CT as part of the trauma assessment. Methods: The patients were divided into two cohorts, based on the results of the initial CT scan: either positive (n = 20) or negative (n = 152) for evidence of intestinal or mesenteric injury. The two cohorts were similar with respect to age, trauma score, and timing of CT scan. The outcome of surgical (n = 23) and conservative management (n = 122) was compared with the initial CT scan results. (Some of the laparotomies were for solid organ injury only.) Results: The sensitivity of the CT scan in the diagnosis of clinically significant intestinal and mesenteric injury is 0.93. The specificity and positive and negative predictive values are 0.95, 0.65, and 0.99, respectively. Conclusion: The CT scan is an excellent test to screen for clinically significant intestinal and mesenteric injury in pediatric patients with blunt abdominal trauma. Because of the lower positive value, other clinical and diagnostic imaging information may help to improve diagnostic accuracy. Most importantly, CT rarely misses a significant intestinal or mesenteric injury. Copyright (C) 1996 by W.B. Saunders Company