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Clinical predictors for the selective use of chest radiographs in pediatric blunt trauma evaluations

Michael A Gittelman1, Javier Gonzalez-del-Rey, Alan S Brody

  • 1Division of Emergency Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio 45229, USA. gittm1@cchmc.org

The Journal of Trauma
|October 21, 2003
PubMed

Insights

In pediatric blunt trauma, chest tenderness, back abrasions, or abnormal respiratory rate accurately identify abnormal chest radiographs. These clinical markers improve diagnostic sensitivity in evaluating young trauma patients.

Area of Science:

  • Pediatric Emergency Medicine
  • Radiology
  • Trauma Care

Background:

  • Chest radiographs are standard for evaluating pediatric blunt trauma.
  • Identifying clinical markers for abnormal radiographs in nonintubated children is crucial.

Purpose of the Study:

  • To determine clinical markers associated with abnormal chest radiographs in pediatric blunt trauma patients.
  • To develop a predictive set of clinical markers with high sensitivity.

Main Methods:

  • Retrospective case-control study of severely injured pediatric trauma patients (1996-1997).
  • Matched four controls for each case with abnormal chest radiographs.
  • Radiographs reevaluated; variables analyzed to identify predictive clinical markers.

Main Results:

  • 30 patients with abnormal radiographs and 133 controls analyzed.
  • Chest tenderness, back abrasions, or abnormal respiratory rate showed 1.0 sensitivity.
  • Specificity for these markers was 0.38.

Conclusions:

  • Chest tenderness, back abrasions, and abnormal respiratory rate identified all abnormal chest radiographs in pediatric trauma.
  • These clinical findings are highly sensitive predictors of radiographic abnormality.
Abstract

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