The Skeptics Guide to Emergency Medicine SGEM #479: Light Em Up Up Up (CT) or Not for Pediatric Blunt Abdominal Trauma?
Jul 5, 2025
In this discussion, Dr. Sandi Angus, a passionate Paediatric and Adult Emergency Medicine Registrar, dives into the complexities of evaluating blunt abdominal trauma in children. They explore the critical balance between the risks of radiation from CT scans and the benefits of accurate diagnosis. The conversation highlights the PECARN rule for identifying low-risk patients and the challenges in interpreting injury risks from various symptoms. Join in as they uncover the intricacies of clinical decision-making in pediatric emergency care!
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Case of a Pediatric Blunt Trauma
- A 10-year-old boy was involved in a high-speed motor vehicle collision and presented with abdominal pain but no clear physical signs of severe injury.
- Despite vomiting once, he had a stable Glasgow Coma Scale of 15 and a soft abdomen without a seatbelt sign.
Challenges Diagnosing Pediatric Abdominal Injuries
- Pediatric intra-abdominal injury diagnosis is challenging due to subtle signs and unreliable physical exams.
- Clinical decision rules like PECARN help reduce unnecessary CTs by identifying low-risk children safely.
Using PECARN to Guide Imaging
- Balance the risks of CT radiation carefully, especially in children due to their increased radiosensitivity.
- Apply the PECARN clinical prediction tool using history and physical exam variables to avoid unnecessary CT scans.