Related Experiment Videos
Chest injury in children with blunt abdominal trauma: evaluation with CT
C J Sivit1, G A Taylor, M R Eichelberger
1Department of Radiology, Children's Hospital National Medical Center, Washington, DC.
Insights
Computed tomography (CT) scans reveal significant chest injuries in 12% of children with blunt abdominal trauma, often missed by initial chest X-rays. Early CT detection improves outcomes for pediatric chest trauma.
Area of Science:
- Pediatric Traumatology
- Diagnostic Imaging
- Thoracic Surgery
Background:
- Blunt abdominal trauma in children can be associated with occult thoracic injuries.
- Initial chest radiographs may underestimate or miss significant chest abnormalities.
- Early identification of chest injuries is crucial for pediatric trauma management.
Purpose of the Study:
- To determine the incidence of chest injuries in children with blunt abdominal trauma.
- To evaluate the accuracy of initial chest radiographs compared to computed tomography (CT).
- To assess the impact of chest injuries on pediatric trauma outcomes.
Main Methods:
- Retrospective review of 512 children undergoing CT for blunt abdominal trauma.
- Comparison of CT findings with initial chest radiographs.
- Analysis of injury patterns, age distribution, physiological stability (trauma scores), and mortality.
Main Results:
- Significant chest injuries were found in 12% (62/512) of children.
- CT identified abnormalities missed or underestimated by initial radiographs in 38% of cases (50% of pleural, 34% of parenchymal injuries).
- Chest injuries were more common in children <7 years and associated with lower trauma scores and increased mortality.
Conclusions:
- Unsuspected or underestimated thoracic injuries are common in pediatric blunt abdominal trauma.
- CT scans, particularly when performed for abdominal evaluation, are valuable for early recognition of pediatric chest injuries.
- Prompt diagnosis and management of chest injuries significantly improve survival rates in pediatric trauma patients.
Abstract:
One or more significant chest injuries were identified in 62 of 512 children (12%) examined with computed tomography (CT) after blunt abdominal trauma. Thirty-eight percent of all abnormalities identified on CT scans were underestimated or missed on the initial chest radiograph. Pleural and parenchymal abnormalities were missed in 50% and 34% of initial chest radiographs, respectively. Chest injuries occurred more frequently in children less than 7 years of age than in older children (62% vs 38%, P less than .02). Children with chest injuries tended to be more physiologically unstable than children without, as determined with lower (worse) mean trauma scores (P less than .001). Both the presence and severity of chest injuries strongly affected outcome. Mortality was 1.3% in children with no chest injury, 10.8% in children with significant unilateral chest injury, and 40% in children with significant bilateral or mediastinal chest injury (P less than .0001). Significant unsuspected or underestimated thoracic injuries are relatively common in children, and CT scans of the chest obtained while examinations of the upper abdomen are being performed can be helpful in the early recognition of such injuries.