Is a complete trauma series indicated for all pediatric trauma victims?

Trauma series radiographs (ie, lateral cervical spine, anteroposterior chest, and anteroposterior pelvis) are routinely recommended for victims of multiple trauma. However, the utility of the chest and pelvic radiographs has never been adequately evaluated. The purpose of this study is to determine whether clinical findings alone predict the results of these radiographs.

The pediatric radiology department at the Jacobi Medical Center, Albert Einstein College of Medicine, Bronx, New York, maintains a log of all patients who have undergone a complete trauma series. From this group, we selected all patients younger than 2 years with a Glasgow Coma Scale greater than 14 points. The patients' emergency department charts were reviewed to note the presence or absence of localizing signs and symptoms referable to the chest and pelvis, including chest or pelvic pain, tenderness, ecchymoses or abrasions, shortness of breath or other respiratory symptoms, hematuria or difficulty voiding, and abdominal distention.

Sixteen of the 91 subjects (18%) had localizing chest findings. Two of these patients had positive chest radiographs, whereas the 75 patients without localizing chest findings had no positive chest radiographs (P < 0.03). Thirty-two of 91 subjects (35%) had localizing pelvic signs. Five of these patients had positive pelvic radiographs, whereas the 56 patients without localizing pelvic signs had no positive pelvic radiographs (P < 0.01). The negative predictive value of localizing signs and symptoms was 100% for both chest and pelvic radiographs.

These data suggest that if an adequate examination can be performed, trauma series radiographs can be ordered selectively, based on the patient's clinical findings.