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Limiting thoracic CT: a rule for use during initial pediatric trauma evaluation.

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|September 21, 2017
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Summary

Thoracic computed-tomography (TCT) use in pediatric trauma has not decreased. Abnormal chest X-rays (CXR) and severe mechanisms predict significant injury, suggesting TCT may be reserved for these cases.

Keywords:
Chest X-rayPediatric blunt traumaThoracic CTThoracic trauma

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Area of Science:

  • Pediatric Trauma Imaging
  • Thoracic Imaging Guidelines
  • Diagnostic Accuracy

Background:

  • Guidelines for thoracic computed-tomography (TCT) in pediatric trauma are lacking, despite established protocols for other body regions.
  • This study investigated TCT utilization trends and its predictive value for significant thoracic injuries in pediatric blunt trauma patients.

Purpose of the Study:

  • To evaluate changes in TCT utilization relative to other computed-tomography (CT) scans in pediatric trauma patients.
  • To determine if injury mechanism and chest radiograph (CXR) findings can predict significant thoracic injury, potentially obviating the need for TCT.
  • To propose a clinical decision rule for TCT use in pediatric blunt trauma.

Main Methods:

  • Retrospective review of pediatric blunt trauma patients (≤18 years) who underwent chest imaging between 2007-2015 at two level-1 trauma centers.
  • Comparison of baseline characteristics and incidence of body region-specific CT scans.
  • Analysis of injury mechanism, intrathoracic pathology, interventions, and diagnostic yield of CXR and TCT.

Main Results:

  • Thoracic computed-tomography (TCT) incidence remained stable, unlike decreased utilization of CT scans for other body regions.
  • Out of 2951 patients, TCT altered management in only 17 cases, including operations and thoracostomy tube placements.
  • All clinically significant findings and interventions were accurately predicted by vehicle-related trauma mechanisms and abnormal chest radiograph (CXR) findings.

Conclusions:

  • Thoracic computed-tomography (TCT) utilization has not decreased in pediatric blunt trauma patients.
  • Chest radiography (CXR) and mechanism of injury effectively predict significant thoracic injuries.
  • A proposed rule suggests reserving TCT for pediatric blunt trauma patients with abnormal CXR findings and severe vehicle-related mechanisms.