• Angela M Ellison, Kimberly S Quayle, Bema Bonsu, Madelyn Garcia, Stephen Blumberg, Alexander Rogers, Sandra L Wootton-Gorges, Benjamin T Kerrey, Lawrence J Cook, Arthur Cooper, Nathan Kuppermann, James F Holmes, Pediatric Emergency Care Applied Research Network (PECARN), and Pediatric Emergency Care Applied Research Network PECARN.
• Department of Pediatrics, Perelman School of Medicine/Children's Hospital of Philadelphia, Philadelphia, PA. Electronic address: ellisona@email.chop.edu.
• Ann Emerg Med. 2015 Aug 1;66(2):107-114.e4.

Study ObjectiveWe compare test characteristics of abdominal computed tomography (CT) with and without oral contrast for identifying intra-abdominal injuries.MethodsThis was a planned subanalysis of a prospective, multicenter study of children (<18 years) with blunt torso trauma. Children imaged in the emergency department with abdominal CT using intravenous contrast were eligible. Oral contrast use was based on the participating centers' guidelines and discretions. Clinical courses were followed to identify patients with intra-abdominal injuries. Abdominal CTs were considered positive for intra-abdominal injury if a specific intra-abdominal injury was identified and considered abnormal if any findings suggestive of intra-abdominal injury were identified on the CT.ResultsA total of 12,044 patients were enrolled, with 5,276 undergoing abdominal CT with intravenous contrast. Of the 4,987 CTs (95%) with documented use or nonuse of oral contrast, 1,010 (20%) were with and 3,977 (80%) were without oral contrast; 686 patients (14%) had intra-abdominal injuries, including 127 CTs (19%) with and 559 (81%) without oral contrast. The sensitivity in the detection of any intra-abdominal injury in the oral contrast versus no oral contrast groups was sensitivitycontrast 99.2% (95% confidence interval [CI] 95.7% to 100.0%) versus sensitivityno contrast 97.7% (95% CI 96.1% to 98.8%), difference 1.5% (95% CI -0.4% to 3.5%). The specificity of the oral contrast versus no oral contrast groups was specificitycontrast 84.7% (95% CI 82.2% to 87.0%) versus specificityno contrast 80.8% (95% CI 79.4% to 82.1%), difference 4.0% (95% CI 1.3% to 6.7%).ConclusionOral contrast is still used in a substantial portion of children undergoing abdominal CT after blunt torso trauma. With the exception of a slightly better specificity, test characteristics for detecting intra-abdominal injury were similar between CT with and without oral contrast.Copyright © 2015 American College of Emergency Physicians. Published by Elsevier Inc. All rights reserved.

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