Reasons for Performing Abdominal Computed Tomography in Pediatric Emergency Departments Providing Trauma Care: A Single-Center Experience

Objective We aimed to evaluate the reasons for abdominal Computed Tomography (CT) in children aged 0–18 years presenting to the Pediatric Emergency Department. Associated factors, the use of imaging modalities other than CT, diagnostic outcomes, and the need for surgical intervention were also assessed. Methods Children aged 0–18 years who presented between January 2018 and December 2022 and underwent abdominal CT, as determined by a pediatrician or pediatric emergency physician, were included. Results A total of 562 patients were analyzed (mean age: 142 months; 55% male). In traumatic cases, the most common CT indications were abdominal tenderness, unreliable physical examination, and hemodynamic instability. In non-traumatic cases, abdominal pain, tenderness, and vomiting predominated. Ultrasonography (US) was used more frequently in non-traumatic cases, while direct CT without US was more common in trauma (p < 0.01). In trauma patients, abdominal tenderness, elevated lipase, elevated transaminases, and penetrating injury were significantly associated with pathology on CT (p = 0.005, p < 0.001, p = 0.016, p = 0.011). Elevated lipase independently increased the odds of detecting pathology 5.45-fold, whereas high-energy trauma reduced the odds by 80%. In non-trauma patients, CT indications were not significantly predictive. For pathology detection, a lipase cutoff ≥ 70 gave an AUC of 0.652 (sensitivity 28%, specificity 96%). Conclusions Accurate diagnosis and optimal management are essential while minimizing CT use. Particularly in children without abnormal exam findings or symptoms, clinical and laboratory results should guide decision-making rather than trauma mechanism alone.