Is computed tomography cystography indicated in children with pelvic fractures?
10.1016/j.cjtee.2019.09.002
- VernacularTitle:Is computed tomography cystography indicated in children with pelvic fractures?
- Author:
Alexander BECKER
1
,
2
;
Ori YASLOWITZ
3
;
Joseph DUBOSE
4
;
Kobi PELEG
5
,
6
;
Yaakov DASKAL
7
;
Adi GIVON
8
;
Boris KESSEL
9
,
10
Author Information
1. Department of Surgery, Emek Medical Center, Afula, Israel
2. The Rappaport School of Medicine, Technion, Haifa, Israel. Electronic address: becker_al@clalit.org.il.
3. Department of Surgery A, Meir Medical Center, Kfar-Saba, Israel.
4. R Adams Cowley Shock Trauma Center, University of Maryland Medical System, Baltimore, MD, USA.
5. National Center for Trauma and Emergency Medicine Research, Gertner Institute for Epidemiology and Health Policy Research, Tel Hashomer, Israel
6. Emergency and Disaster Management Department, Faculty of Medicine, School of Public Health, Tel-Aviv University, Israel.
7. Trauma Unit, Hillel Yaffe Medical Center, Hadera, Israel.
8. National Center for Trauma and Emergency Medicine Research, Gertner Institute for Epidemiology and Health Policy Research, Tel Hashomer, Israel.
9. The Rappaport School of Medicine, Technion, Haifa, Israel
10. Trauma Unit, Hillel Yaffe Medical Center, Hadera, Israel.
- Collective Name:Israel Trauma Group
- Publication Type:Journal Article
- Keywords:
Bladder injury;
Child;
Cystography;
Pelvic fracture;
Tomography, X-ray computed
- MeSH:
Adolescent;
Child;
Child, Preschool;
Cohort Studies;
Cystography;
methods;
Female;
Fractures, Bone;
diagnostic imaging;
Humans;
Infant;
Male;
Pelvic Bones;
diagnostic imaging;
injuries;
Risk;
Tomography, X-Ray Computed;
methods;
Unnecessary Procedures;
Urinary Bladder;
diagnostic imaging;
injuries
- From:
Chinese Journal of Traumatology
2020;23(3):181-184
- CountryChina
- Language:English
-
Abstract:
PURPOSE:Pelvic fracture evaluation with abdominopelvic computed tomography (CT) and formal CT cystography for rule out of urine bladder injury have been commonly employed in pediatric trauma patients. The additional delayed imaging required to obtain optimal CT cystography is, however, associated with increased doses of ionizing radiation to pelvic organs and represent a significant risk in the pediatric population for future carcinogenic risk. We hypothesized that avoidance of routine CT cystography among pediatric pelvic fracture victims would not result in an appreciable rate of missed bladder injuries and would aid in mitigating the radiation exposure risk associated with these additional images.
METHODS:A retrospective cohort study involving blunt trauma pelvic fractures among pediatric trauma patients (age<14) between the years 1997 and 2016 was conducted utilizing the Israeli National Trauma Registry. Statistical analysis was performed using SAS statistical software version 9.4 via the tests of Chi-square test and two-sided Fisher's exact test. A p value of less than 0.05 was considered statistically significant.
RESULTS:A total of 1072 children were identified from the registry for inclusion. Mean age of patients was 7.7 years (range 0-14) and 713 (66.5%) were male. Overall mortality in this population was 4.1% (44/1072). Only 2.1% (23) of pediatric patients with pelvic fractures had bladder injury identified, with just 9 children having intraperitoneal bladder rupture (0.8% of all the patients).
CONCLUSION:The vast majority of blunt pediatric trauma victims with pelvic fractures do not have urine bladder injuries. Based on our study results we do not recommend the routine utilization of CT cystography in this unique population.
