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2023 In paediatric trauma patients presenting to a paediatric major trauma centre, does the choosing wisely criteria safely reduce the rate of abdominal CT scanning?
  1. Nyle Reece1,
  2. Shrouk Messahel2
  1. 1University of Liverpool
  2. 2Alder Hey Children’s Hospital


Aims and Objectives Intra-abdominal injury is found in only 25% of paediatric trauma patients representing a large proportion of patients undergoing unnecessary exposure to ionising radiation and increased cancer risk from CT abdomen scans. Multiple guidelines exist to aid decision-making for CT abdomen requisition in trauma patients. Alder Hey Children’s Hospital use the North West Children’s Major Trauma Network guidelines (NWCMTN) for CT abdomen requisitions in trauma. A level one paediatric trauma centre in Canada developed the Choosing Wisely criteria which resulted in a statistically significant absolute reduction in CT abdomen scanning by 20% with no missed injuries.


  • Assess adherence to NWCMTN guidelines

  • Quantify patients at very low risk of intra–abdominal injury as per Choosing Wisely to determine whether CT abdomens could be safely reduced

Method and Design A retrospective MediTech data search identified 249 CT abdomens performed for patients presenting to the ED at Alder Hey between September 2019 and December 2022 for retrospective comparison against NWCMTN guidelines and the Choosing Wisely criteria.

Primary outcomes were the number of CT abdomens performed, CT outcome and the proportion of scans that adhered to NWCMTN guidelines.

Results and Conclusion Intra-abdominal injury was found in 20.9% of all scans. 96.4% of CT abdomen requisitions adhered to NWCMTN guidelines. NWCMTN guidelines identified 3.6% of patients with no indications for a CT abdomen. The Choosing Wisely criteria identified 5.2% of patients at very low risk of intra-abdominal injury with no indications for a CT abdomen.

Almost all decisions to perform a CT abdomen in paediatric major trauma in the ED at Alder Hey are consistent with the NWCMTN guidelines. CT abdomen scans could be safely reduced by adopting the Choosing Wisely criteria. This audit highlights the importance of maximising guideline adherence and the challenge of identifying patients at very low risk of intra-abdominal injury.

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