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Chest x-ray vs. computed tomography of the chest in pediatric blunt trauma
Irma T Ugalde1, Samuel Prater1, Marylou Cardenas-Turanzas2
1Department of Emergency Medicine, McGovern Medical School at UT Health Sciences Center, Houston, TX.
Insights
Chest x-ray (CXR) is a useful initial tool for pediatric trauma, but computed tomography of the chest (CCT) detects more injuries. CCT findings altered management in 8.7% of children, including surgical interventions.
Area of Science:
- Radiology
- Pediatric Imaging
- Trauma Imaging
Background:
- Chest x-ray (CXR) is an established tool for detecting significant trauma in children.
- Computed tomography of the chest (CCT) offers a more detailed imaging modality.
Purpose of the Study:
- To compare findings between CXR and CCT in pediatric trauma patients.
- To assess the impact of CCT findings on clinical management.
- To evaluate the diagnostic performance of CXR in this population.
Main Methods:
- Retrospective study of children (<18 years) who underwent both CXR and CCT (2009-2015).
- Univariate analysis to compare patient characteristics.
- Evaluation of CCT's diagnostic yield, sensitivity, and specificity compared to CXR.
- Analysis of changes in clinical management based on CCT findings.
Main Results:
- CCT identified significantly higher proportions of contusion, atelectasis, pneumothorax, rib fractures, other fractures, diaphragm rupture, and incidental findings compared to CXR.
- CCT findings led to management changes in 8.7% of patients, with 2.6% requiring surgery.
- CXR demonstrated a sensitivity of 57.9% and specificity of 90.2% for detecting significant trauma.
Conclusions:
- CXR serves as a valuable initial screening tool for pediatric trauma patients in the emergency department.
- CXR performance should be considered alongside clinical presentation for optimal patient evaluation.
- CCT provides crucial additional diagnostic information that can alter patient management.
Introduction:
Chest x-ray (CXR) has been shown to be an effective detection tool for clinically significant trauma. We evaluated differences in findings between CXR and computed tomography of the chest (CCT), their impact on clinical management and the performance of the CXR.
Methods:
This retrospective study examined children (less than 18 years) who received a CXR and CCT between 2009 and 2015. We compared characteristics of children by conducting univariate analysis, reporting the proportion of additional diagnoses captured by CCT, and using it to evaluate the sensitivity and specificity of the CXR. Outcome variables were diagnoses made by CCT as well as the ensuing changes in the clinical management attributable to the diagnoses reported by the CCT and not observed by the CXR.
Results:
In 1235 children, CCT was associated with diagnosing higher proportions of contusion or atelectasis (60% vs 31%; p < .0001), pneumothorax (23% vs 9%; p < .0001), rib fracture (18% vs 7%; p < .0001), other fracture (20% vs 10%; p < .0001), diaphragm rupture (0.2% vs 0.1%; p = .002), and incidental findings (7% vs 2%; p < .0001) as compared to CXR. CCT findings changed the management of 107 children (8.7%) with 32 (2.6%) of the changes being surgical procedures. The overall sensitivity and specificity of the CXR were 57.9% (95% CI: 54.5-61.2) and 90.2% (95% CI: 86.8-93.1), respectively. The positive predictive value and negative predictive value were 93.1% and 48.6%, respectively.
Conclusion:
CXR is a useful initial screening tool to evaluate pediatric trauma patients along with clinical presentation in the Emergency Department in children.
Level Of Evidence:
Level III, diagnostic test.
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