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Chest x-ray as a screening tool for blunt thoracic trauma in children

Natalie L Yanchar1, Kenneth Woo, Maureen Brennan

  • 1From the Division of Pediatric General Surgery and IWK Trauma Care Program (N.L.Y., K.W.), IWK Health Centre, Halifax, Nova Scotia; and Pediatric Trauma Program (M.B.), Children's Hospital of Eastern Ontario; and Pediatric Trauma Program (B.S.), Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada; and Department of Epidemiology and Preventive Medicine (C.S.P.), Monash University; and Trauma Service (C.S.P., J.C.), Royal Children's Hospital, Melbourne; and Division of Women's, Adolescent and Children's Services (M.Z.E.), Royal Hobart Hospital, Hobart, Tasmania, Australia.

The Journal of Trauma and Acute Care Surgery
|September 26, 2013
PubMed

Insights

Chest X-rays (CXR) can identify significant thoracic injuries in pediatric blunt thoracic trauma (BTT), guiding selective use of CT scans. Normal CXR findings do not rule out injury, but CXR is valuable for screening.

Area of Science:

  • Pediatric Trauma Care
  • Diagnostic Imaging in Pediatrics
  • Thoracic Injury Assessment

Background:

  • Increasing use of computed tomography (CT) for pediatric blunt thoracic trauma (BTT) necessitates selective imaging strategies.
  • Clinical and radiologic variables may predict significant thoracic injuries, informing CT utilization.
  • Factors influencing the decision to obtain thoracic CT may differ from those predicting injury severity.

Purpose of the Study:

  • To determine if chest X-ray (CXR) and other variables predict significant thoracic injuries in pediatric BTT.
  • To assess if these predictors differ from factors associated with the decision to obtain a thoracic CT.
  • To inform the selective use of CT in pediatric BTT.

Main Methods:

  • Retrospective cohort study of pediatric BTT cases from three Level I trauma centers (April 1999 - March 2008).
  • Logistic regression analysis of pre-CT variables to identify associations with CT-confirmed thoracic injuries and the decision to obtain CT.
  • Evaluation of epidemiologic, clinical, and radiologic data.

Main Results:

  • 40% of patients had significant thoracic injuries.
  • CXR presence of hydrothorax/pneumothorax (aOR 10.8) and isolated subcutaneous emphysema (aOR 19.8) significantly increased the likelihood of significant chest injury.
  • Normal CXR did not rule out significant injury, with 8/9 cases having occult pneumothoraces or hemothoraces; CT decision was linked to study period and other CT scans.

Conclusions:

  • Chest X-ray (CXR) is effective in screening for significant thoracic injuries in pediatric blunt thoracic trauma (BTT).
  • CXR findings can guide the selective use of thoracic computed tomography (CT).
  • Prospective studies are needed to validate findings and develop evidence-based guidelines for CT indications in pediatric BTT.
Abstract

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