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The utility of computed tomography as a screening tool for the evaluation of pediatric blunt chest trauma
Troy A Markel1, Rajiv Kumar, Nicholas A Koontz
1Department of Surgery, Indiana University School of Medicine, Indianapolis, Indiana, USA.
Insights
Computed tomography (CT) use for pediatric chest trauma increased significantly, while chest X-ray (CXR) use decreased. CXR remains a viable screening tool, but guidelines are needed to standardize CT use and reduce radiation exposure in children.
Area of Science:
- Pediatric Radiology
- Trauma Imaging
- Medical Imaging Trends
Background:
- Growing concern regarding the overuse of computed tomography (CT) in pediatric patients.
- Need to analyze the utility of chest CT versus chest X-ray (CXR) for pediatric blunt chest trauma.
Purpose of the Study:
- To analyze trends in chest CT and CXR utilization for pediatric blunt chest trauma.
- To compare the diagnostic yield and clinical impact of CT and CXR in this population.
Main Methods:
- Retrospective review of pediatric patients undergoing chest CT within 24 hours of blunt trauma.
- Analysis of trends in CT and CXR use over a 4-year period.
- Comparison of radiology report findings with clinical outcomes.
Main Results:
- Chest CT use in children increased from 5.5% to 10.5% (p < 0.001) between 2001-2005.
- Initial CXR use decreased from 84% to 56% (p < 0.001) in patients who underwent CT.
- Twenty percent of chest CTs revealed significant findings; CXR had a 5% false-normal rate that could impact management.
Conclusions:
- Rapid increase in CT use for initial pediatric chest trauma evaluation, with a concurrent decrease in CXR.
- CXR remains an acceptable screening tool for identifying patients who may benefit from CT.
- Development of multidisciplinary guidelines is crucial to standardize CT use and minimize radiation exposure in pediatric patients.
Background:
There is a growing concern that computed tomography (CT) is being unnecessarily overused for the evaluation of pediatric patients. The purpose of this study was to analyze the trends and utility of chest CT use compared with chest X-ray (CXR) for the evaluation of children with blunt chest trauma.
Methods:
A 4-year retrospective review was performed for pediatric patients who underwent chest CT within 24 hours of sustaining blunt trauma at a Level-I trauma center. Trends in the use of CT and CXR were documented, and results of radiology reports were analyzed and compared with clinical outcomes.
Results:
Three hundred thirty-three children, mean age 11 years, had chest CTs, increasing from 5.5% in 2001-2002 to 10.5% in 2004-2005 (p < 0.001). Conversely, in those children who underwent chest CT, the rate of initial CXR use decreased from 84% to 56% during the same period (p < 0.001). Twenty percent of chest CTs had significant positive findings. Six patients underwent emergency surgery for cardiac or arterial injuries, and all demonstrated abnormal findings on CXR or CT scout imaging. When compared with the CT, only 5% of initial CXRs falsely reported normal findings that may have altered management.
Conclusions:
CT use in children has increased rapidly for the initial evaluation of chest trauma, whereas CXR use has decreased. Despite this trend, CXR remains an acceptable screening tool to analyze which patients may require CT evaluation. A multidisciplinary approach is warranted to develop guidelines that standardize the use of CT and thereby decreases unnecessary radiation exposure to pediatric patients.
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