{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,27]],"date-time":"2026-10-27T12:38:13Z","timestamp":1793104693266,"version":"4.5.0"},"reference-count":29,"publisher":"Wiley","issue":"7","license":[{"start":{"date-parts":[[2018,5,16]],"date-time":"2018-05-16T00:00:00Z","timestamp":1526428800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/100009633","name":"Eunice Kennedy Shriver National Institute of Child Health and Human Development","doi-asserted-by":"publisher","award":["T32, HD057822"],"award-info":[{"award-number":["T32, HD057822"]}],"id":[{"id":"10.13039\/100009633","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Academic Emergency Medicine"],"published-print":{"date-parts":[[2018,7]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>The risk of radiation exposure from computed tomography (<jats:styled-content style=\"fixed-case\">CT<\/jats:styled-content>) imaging in children is well recognized. Patient history and physical examination findings, including costal margin tenderness (<jats:styled-content style=\"fixed-case\">CMT<\/jats:styled-content>), influence a physician's decision to image a child with blunt torso trauma. The objective of this study was to determine the importance of <jats:styled-content style=\"fixed-case\">CMT<\/jats:styled-content> for identifying children with intraabdominal injuries (<jats:styled-content style=\"fixed-case\">IAI<\/jats:styled-content>) found on <jats:styled-content style=\"fixed-case\">CT<\/jats:styled-content> and <jats:styled-content style=\"fixed-case\">IAI<\/jats:styled-content> undergoing acute intervention.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We conducted an analysis of the Pediatric Emergency Care Applied Research Network (<jats:styled-content style=\"fixed-case\">PECARN<\/jats:styled-content>) <jats:styled-content style=\"fixed-case\">IAI<\/jats:styled-content> public use data set, representing a large prospective multicenter cohort study from May 2007 to January 2010. Isolated <jats:styled-content style=\"fixed-case\">CMT<\/jats:styled-content> was defined as <jats:styled-content style=\"fixed-case\">CMT<\/jats:styled-content> without other identified <jats:styled-content style=\"fixed-case\">PECARN<\/jats:styled-content> risk factors for <jats:styled-content style=\"fixed-case\">IAI<\/jats:styled-content> (i.e., abdominal or thoracic wall trauma, abdominal tenderness or pain, decreased breath sounds, or vomiting). Logistic regression was used to calculate adjusted odds of <jats:styled-content style=\"fixed-case\">IAI<\/jats:styled-content> in children presenting with isolated and nonisolated <jats:styled-content style=\"fixed-case\">CMT<\/jats:styled-content>. Risk differences were calculated to estimate the risk of <jats:styled-content style=\"fixed-case\">IAI<\/jats:styled-content> independently attributable to <jats:styled-content style=\"fixed-case\">CMT<\/jats:styled-content> in the setting of isolated <jats:styled-content style=\"fixed-case\">PECARN<\/jats:styled-content> risk factors. Finally, <jats:styled-content style=\"fixed-case\">CT<\/jats:styled-content> use among exposure groups was estimated to quantify potentially avoidable imaging.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Among 9,174 children with Glasgow Coma Scale scores of 14 or 15 who sustained blunt torso trauma, 1,267 (13.8%) had <jats:styled-content style=\"fixed-case\">CMT<\/jats:styled-content>. Among those with <jats:styled-content style=\"fixed-case\">CMT<\/jats:styled-content>, 177 (14.0%) had isolated <jats:styled-content style=\"fixed-case\">CMT<\/jats:styled-content> and 1,090 (86.0%) had nonisolated <jats:styled-content style=\"fixed-case\">CMT<\/jats:styled-content>. No children (0\/177; 0%, 95% confidence interval [<jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content>]\u00a0= 0.0%\u20132.1%) with isolated <jats:styled-content style=\"fixed-case\">CMT<\/jats:styled-content> had <jats:styled-content style=\"fixed-case\">IAI<\/jats:styled-content>, compared to 17.2% (187\/1,090; 95% <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content>\u00a0= 15.0%\u201319.5%) of those with nonisolated <jats:styled-content style=\"fixed-case\">CMT<\/jats:styled-content>. The risk differences were not statistically significant. 36\/177 (20.3%; 95% <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content>\u00a0= 14.7%\u201327.0%) children with isolated <jats:styled-content style=\"fixed-case\">CMT<\/jats:styled-content> underwent abdominal <jats:styled-content style=\"fixed-case\">CT<\/jats:styled-content> scans.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>The risk of <jats:styled-content style=\"fixed-case\">IAI<\/jats:styled-content> associated with isolated <jats:styled-content style=\"fixed-case\">CMT<\/jats:styled-content> is minimal. For children with blunt abdominal trauma and isolated <jats:styled-content style=\"fixed-case\">CMT<\/jats:styled-content>, abdominal <jats:styled-content style=\"fixed-case\">CT<\/jats:styled-content> scan is of low yield.<\/jats:p><\/jats:sec>","DOI":"10.1111\/acem.13426","type":"journal-article","created":{"date-parts":[[2018,4,14]],"date-time":"2018-04-14T03:06:43Z","timestamp":1523675203000},"page":"776-784","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":10,"title":["Costal Margin Tenderness and the Risk for Intraabdominal Injuries in Children With Blunt Abdominal Trauma"],"prefix":"10.1111","volume":"25","author":[{"given":"Katherine T.","family":"Flynn\u2010O'Brien","sequence":"first","affiliation":[{"name":"Department of Surgery University of Washington Seattle WA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nathan","family":"Kuppermann","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine UC Davis School of Medicine Sacramento CA"},{"name":"Department of Pediatrics UC Davis School of Medicine Sacramento CA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"James F.","family":"Holmes","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine UC Davis School of Medicine Sacramento CA"},{"name":"Department of Pediatrics UC Davis School of Medicine Sacramento CA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2018,5,16]]},"reference":[{"key":"e_1_2_8_2_1","unstructured":"Centers for Disease Control and Prevention.Web\u2010based Injury Statistics Query and Reporting System (WISQARS).2014. 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