Computed tomography in pediatric blunt abdominal trauma: current evidence, challenges, and future directions — a systematic review and meta-analysis

TL;DR

This study reviews the use of CT scans in diagnosing abdominal injuries in children, finding high detection rates but low intervention and mortality, suggesting selective use of CT to reduce risks.

Contribution

The study provides a systematic review and meta-analysis of CT use in pediatric blunt abdominal trauma, emphasizing the need for selective imaging and future research on non-ionizing alternatives.

Findings

The pooled median prevalence of intra-abdominal injuries in children was 84.5%, with liver, bowel, spleen, and kidney injuries being most common.

Intervention and mortality rates were low at 7.7% and 1.4%, respectively, suggesting limited need for routine CT scans.

Higher injury probabilities were associated with increasing age and male predominance, while non-solid organ injuries were rare.

Abstract

Assessment of intra-abdominal injuries (IAIs) in children is challenging due to unreliable physical examination, communication barriers, and the serious consequences of missed injuries. Computed tomography (CT) is widely used for its high sensitivity, but concerns persist regarding radiation exposure and resource utilization. This systematic review and meta-analysis aimed to quantify IAI prevalence, describe organ-specific injury patterns, and evaluate intervention and mortality outcomes in children with blunt abdominal trauma assessed using CT.

We searched PubMed, Web of Science, Cochrane Library, and Scopus through August 2025 for studies evaluating pediatric blunt abdominal trauma, CT-based assessment, and CT-detected IAIs. Bayesian random-effects meta-analyses were used to estimate pooled prevalence and outcomes, with additional hierarchical and meta-regression models for organ-specific injuries and study-level covariates. Certainty of evidence was assessed using the GRADE framework.

Fifteen studies including 7,430 children were analyzed. The pooled posterior median prevalence of IAI was 84.5% (95% credible interval [CrI]: 62–94%), while the probability of intervention was 7.7% and mortality was 1.4%. Solid organ injuries predominated, with liver (13.1%, 95% CrI: 4.9–45.5%), bowel (11.2%, 4.2–40.9%), spleen (11.1%, 4.1–40.4%), and kidney (8.7%, 3.2–34.3%) injuries most common; adrenal (3.4%) and pancreatic (1.4%) injuries were rare. Meta-regression showed higher injury probabilities with increasing age and male predominance. Injury Severity Score–based subgroup analyses yielded substantially lower IAI probabilities (11–12%), reflecting broader trauma populations. Certainty of evidence was moderate for overall IAI prevalence and low for other outcomes due to heterogeneity and sparse events.

Although CT is highly sensitive for detecting IAIs in pediatric blunt abdominal trauma, low rates of intervention and mortality support selective CT use guided by validated decision rules and observation rather than routine imaging. Future research should prioritize multicenter prospective studies, pragmatic implementation of decision tools, and development of non-ionizing imaging alternatives to optimize CT use and minimize long-term risks in children.

The online version contains supplementary material available at 10.1186/s13049-026-01578-5.

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