gms | German Medical Science

Deutscher Kongress für Orthopädie und Unfallchirurgie, 75. Jahrestagung der Deutschen Gesellschaft für Unfallchirurgie, 97. Tagung der Deutschen Gesellschaft für Orthopädie und Orthopädische Chirurgie, 52. Tagung des Berufsverbandes der Fachärzte für Orthopädie und Unfallchirurgie

25. - 28.10.2011, Berlin

Avoid CT in hemodynamic stable children with abdominal injury

Meeting Abstract

  • D.R. Nellensteijn - UMCG, Traumachirurgie, Groningen, Netherlands
  • J. Groen - UMCG, Stralingsfysica/Radiologie, Groningen, Netherlands
  • vanT.H. Zwieten - UMCG, Groningen, Netherlands
  • DuisH.J. ten - UMCG, Traumachirurgie, Groningen, Netherlands
  • J.B.F. Hulscher - UMCG, Kinderchirurgie, Groningen, Netherlands

Deutscher Kongress für Orthopädie und Unfallchirurgie. 75. Jahrestagung der Deutschen Gesellschaft für Unfallchirurgie, 97. Tagung der Deutschen Gesellschaft für Orthopädie und Orthopädische Chirurgie, 52. Tagung des Berufsverbandes der Fachärzte für Orthopädie. Berlin, 25.-28.10.2011. Düsseldorf: German Medical Science GMS Publishing House; 2011. DocWI60-796

doi: 10.3205/11dkou383, urn:nbn:de:0183-11dkou3839

Published: October 18, 2011

© 2011 Nellensteijn et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.



Questionnaire: Non operative management (NOM) of solid organ injuries in hemodynamically stable children is now generally accepted as the standard of care. CT scans are often used to assess injury, even in hemodynamically stable children. However, previous studies show poor correlation between grade of injury and the outcome of NOM. Furthermore CT imaging has never been validated for grading abdominal injuries. Despite the evolution of modern CT scanners radiation dosage and associated risks are still substantial, especially in the paediatric population. Therefore we set out to determine the therapeutic value of CT scans in relation to the radiation dose, lifetime tumour incidence and tumour mortality by radiation for our patients.

Methods: All hemodynamically stable patients undergoing abdominal CT scans for trauma in the emergency setting between 2005 and 2009 in our hospital were reviewed. Subsequently the notes of these patients were analysed for: injury, (non) operative therapy, radiological interventions and hemodynamic parameters on admission. From the original scans we calculated the radiation risks.

Results and Conclusions: Seventy two patients were scanned; nine were hemodynamically instable and therefore excluded. Only in two out of sixty three cases a CT scan brought forward an indication for intervention. Therefore in 61 patients (97%) a CT scan was performed that did not influence treatment. Patients received (median/range) 11,43/ 1,185-23,76 mSv adding up to 0,17%/0,05-0,67% accumulated tumour incidence and 0,08%/ 0,02-0,28% mortality.

Of the 63 hemodynamically stable patients who received an abdominal CT, two (3%) underwent, debatably unnecessary, surgical or radiological intervention. In the remaining 61 patients CT scans did not change management. Cumulative cancer risk and cancer mortality in these patients was 0,17% and 0,08% resp. Therefore CT scans should be avoided in the hemodynamically stable patient.