Review of Interventions and Radiation Exposure from Chest Computed Tomography in Children with Blunt Trauma

Area of Science:

• Pediatric Radiology
• Medical Imaging Safety
• Radiation Oncology

Background:

• Chest computed tomography (CCT) is frequently used in pediatric trauma evaluation.
• The radiation dose from CCT raises concerns about potential long-term risks, including malignancy.
• Understanding the diagnostic yield of CCT in identifying actionable injuries is crucial for optimizing imaging protocols.

Purpose of the Study:

• To assess the radiation risk associated with CCT in children undergoing trauma evaluation.
• To determine the effective radiation dose per clinically actionable injury identified by CCT.
• To evaluate the impact of CCT findings on patient management in pediatric blunt trauma.

Main Methods:

• Observational, cross-sectional study of pediatric blunt trauma patients (<18 years) undergoing CCT.
• Retrospective chart review to identify therapeutic interventions for chest injuries identified on CCT.
• Calculation of effective radiation dose per CCT and determination of the dose required for one management-changing injury.

Main Results:

• Of 209 children, 168 had blunt trauma and underwent CCT.
• Ten children required interventions for chest injuries identified on CCT, with an estimated 1 malignancy per 37 actionable injuries.
• No interventions were solely based on CCT findings; all actionable injuries were detectable via other modalities.

Conclusions:

• CCT in pediatric blunt trauma rarely leads to management changes.
• The radiation dose per management-changing injury is high, warranting a review of current CCT imaging practices in this population.
• Alternative imaging modalities should be considered when feasible to reduce radiation exposure.