We have published about this in the PECARN network. Although oral contrast still being used at some centers, no significant difference in detection of intra-abdominal injury
Here is the abstract:
Ann Emerg Med. 2015 Aug;66(2):107-114.e4. doi: 10.1016/j.annemergmed.2015.01.014. Epub 2015 Mar 17.
Use of Oral Contrast for Abdominal Computed Tomography in Children With Blunt Torso Trauma.
Ellison AM1, Quayle KS2, Bonsu B3, Garcia M4, Blumberg S5, Rogers A6, Wootton-Gorges SL7, Kerrey BT8, Cook LJ9, Cooper A10, Kuppermann N11, Holmes JF12; Pediatric Emergency Care Applied Research Network (PECARN); Pediatric Emergency Care Applied Research Network PECARN.
We compare test characteristics of abdominal computed tomography (CT) with and without oral contrast for identifying intra-abdominal injuries.
This 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.
A 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%).
Oral 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.
P.S. We all need to advocate to keep EMSC funded! Children's lives are at stake
Nathan Kuppermann, MD, MPH
Professor, Departments of Emergency Medicine and Pediatrics
Bo Tomas Brofeldt Endowed Chair, Department of Emergency Medicine
University of California, Davis School of Medicine
Principal Investigator, PRIME Node, Pediatric Emergency Care Applied Research Network (PECARN)
Chair, Steering Committee, (global) Pediatric Emergency Research Networks (PERN)
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On Jun 28, 2017, at 11:04 AM, Maureen McCollough <[log in to unmask]> wrote:
> Hi all,
> I am having difficulty getting oral contrast removed from pediatric
> patients needing abd/pelvic CT scans in the ED. I know many institutions
> have abandoned it for ED patients both adult and kids. I work at one place
> and am associated with another place that both have abandoned oral
> contrast, and another one that hasn't yet.
> I am wondering if folks who have protocols that no longer include oral
> contrast, address this issue, etc could send them to me off-line.
> Maureen McCollough
> For more information, send mail to [log in to unmask] with the message: info PED-EM-L
> The URL for the PED-EM-L Web Page is:
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