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A trauma series in the injured child: do we really need it?
Soundappan Soundappan1, Neil F Smith, Lawrence T Lam
1Department of Academic Surgery and Trauma, The Children's Hospital at Westmead, The University of Sydney, Westmead, New South Wales, Australia. ss@chw.edu.au
Insights
Selective trauma series X-rays in conscious pediatric patients may be safe, reducing radiation exposure. This approach aims to minimize unnecessary ionizing radiation for children and healthcare professionals during trauma evaluations.
Area of Science:
- Pediatric Emergency Medicine
- Radiology
- Trauma Care
Background:
- Trauma series radiographs are commonly used in pediatric trauma evaluations.
- The necessity and impact of routine trauma series in children require further investigation.
Purpose of the Study:
- To evaluate the utilization of trauma series radiographs in pediatric patients requiring trauma team activation.
- To identify factors associated with positive radiographic findings in pediatric trauma.
Main Methods:
- Retrospective review of 274 children under 16 years old presenting with trauma requiring trauma team activation.
- Exclusion of patients transferred from other institutions.
- Analysis of radiographic findings and clinical variables.
Main Results:
- 131 children had a complete trauma series, 104 had partial series, and 39 had no radiographs.
- Significant predictors for positive chest X-ray findings included distracting chest injury, abnormal auscultation, and need for intubation.
- No clinical variables correlated significantly with abnormal lateral cervical spine or AP pelvis radiographs.
Conclusions:
- Selective use of trauma series components in conscious pediatric patients with adequate clinical exams is suggested as safe.
- This selective approach can reduce ionizing radiation exposure for pediatric trauma patients and staff.
- Optimizing radiographic protocols can enhance patient safety and resource utilization in pediatric trauma care.
Background:
To study the use of trauma series radiographs in children that required activation of a trauma call.
Methods:
A retrospective review of patients younger than 16 years who presented to The Children's Hospital at Westmead between January and December 2004 with an injury that required activation of the trauma team. Patients transferred from other institutions were excluded.
Results:
Two hundred seventy-four children were included in the study, with 166 boys. The mean age was 8 years, and average Injury Severity Score was 4. Sixteen children had an Injury Severity Score of above 15. One hundred thirty-one children had a complete trauma series performed; 104 had one or more of the series performed, whereas 39 had no radiographs. Data analysis revealed that patients with findings in a chest radiograph (13) had either chest wall contusion(s) or reduced air entry on the involved side. Logistic regression analyses identified features that were significantly associated with a positive finding on the radiographs of the anteroposterior chest including a distracting injury in the chest area (odds ratio [OR], 10.49; 95% confidence interval [CI], 2.98-36.97), abnormal air entry on auscultation (OR, 31.86; 95% CI, 2.80-365.12), and need for intubation (OR, 6.23; 95% CI, 1.56-24.91). However, no clinical variable(s) showed a statistically significant correlation with abnormal radiographic findings on the lateral cervical spine (2) or anteroposterior pelvis (4).
Conclusions:
This study suggests that selective use of individual components of the full trauma series in the conscious pediatric patient, when an adequate clinical examination can be performed, would be safe. This approach should reduce the exposure to ionizing radiation of pediatric trauma patients and hospital staff.
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