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    Is computed tomography cystography indicated in children with pelvic fractures?

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    Author
    Becker, A.
    Dubose, J.
    Israel Trauma Group
    Date
    2020
    Journal
    Chinese Journal of Traumatology - English Edition
    Publisher
    Elsevier B.V.
    Type
    Article
    
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    See at
    https://doi.org/10.1016/j.cjtee.2019.09.002
    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.
    Keyword
    Bladder injury
    Child
    Cystography
    Pelvic fracture
    Tomography X-ray computed
    Identifier to cite or link to this item
    https://www.scopus.com/inward/record.uri?eid=2-s2.0-85078467865&doi=10.1016%2fj.cjtee.2019.09.002&partnerID=40&md5=844883da6b3f05a51e79a226cb531604; http://hdl.handle.net/10713/11669
    ae974a485f413a2113503eed53cd6c53
    10.1016/j.cjtee.2019.09.002
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