Computed Tomography of the Chest in Younger Pediatric Patients with Thoracic Blunt Trauma Rarely Changes Surgical
Irma T Ugalde1, Hei Kit Chan1, Donna Mendez1
1McGovern Medical School at UTHealth Houston, Department of Emergency Medicine, Houston, Texas.
Insights
Older children with blunt chest trauma benefit more from chest computed tomography (CCT) scans, leading to significant changes in clinical and surgical management. Younger children, however, show limited changes in management despite additional diagnoses from CCT.
Area of Science:
- Pediatric Trauma Surgery
- Diagnostic Imaging in Children
- Thoracic Injury Management
Background:
- Blunt chest trauma is a significant cause of mortality in children, second only to traumatic brain injury.
- Thoracic trauma accounts for 80% of pediatric trauma cases.
- Investigating age-related differences in management is crucial for optimizing care.
Purpose of the Study:
- To test the hypothesis that older children experience greater clinical and surgical management changes compared to younger children after screening for intrathoracic injury.
- To analyze the impact of chest computed tomography (CCT) on management decisions across different pediatric age groups.
Main Methods:
- Retrospective observational study of 1,235 pediatric patients with blunt trauma.
- Analysis of chest radiograph and CCT findings.
- Logistic regression and trend tests to assess CCT diagnoses and management changes by age group.
Main Results:
- Clinical management changes increased with age, from 3.9% in 0-2 year olds to 10.9% in 14-17 year olds.
- Surgical management changes were observed in older age groups, rising from 0% in 0-2 year olds to 4.7% in 14-17 year olds.
- A 10% increase in overall management change and a 30% increase in surgical management change were associated with each additional year of life.
Conclusions:
- Chest computed tomography (CCT) has a limited impact on clinical and surgical management decisions in younger children.
- While CCT may reveal additional diagnoses in younger patients, these findings seldom lead to significant changes in care.
- Management changes driven by CCT findings are more pronounced in older pediatric patients.
Introduction:
Thoracic trauma is the second leading cause of death after traumatic brain injury in children presenting with blunt chest trauma, which represents 80% of thoracic trauma in children. We hypothesized that older children undergo more clinical and surgical changes in management than younger children screened for intrathoracic injury at a single, urban, pediatric Level I trauma center.
Methods:
In this retrospective observational study, we determined the frequencies and types of lesions diagnosed only by chest computed tomography (CCT) and resulting changes of clinical and surgical management among different age groups in a pediatric cohort examined for blunt trauma with chest radiograph and CCT. We used logistic regression to quantify variations in CCT diagnoses and changes in clinical and surgical management across age groups. For each age category, we determined the odds ratio for diagnosis made only on CCT and subsequent changes in all clinical management and, specifically, surgical management. We performed the test of trend to determine the relationship across age with changes in management resulting from additional diagnoses made by CCT.
Results:
We analyzed data on 1,235 patients screened for intrathoracic injury. We found the following overall clinical management and surgical management changes, respectively, per age group: 0-2 years, 5/128 (3.9) and 0/128 (0.0); 3-6 years, 11/212 (5.2) and 1/212 (0.5); 7-10 years, 16/175 (9.1) and 2/175 (1.1); 11-13 years, 17/188 (9.0) and 3/188 (1.6); 14-17 years, 58/532 (10.9) and 25/532 (4.7). There were no observed surgical management changes in the 0-2 age group and, thus, no estimated odds ratio could be calculated. The adjusted odds ratios for the occurrence of surgical change in management (14-17 age group as reference) was 0.1 (0.0-0.9) for 3-6 years, 0.3 (0.1-1.3) for 7-10 years, and 0.3 (0.1-1.1) for 11-13 years. The trend of odds ratios across ages showed that with every subsequent year of life there was a 10% increase in management change and a 30% increase in surgical management change.
Conclusion:
Chest computed tomography plays a limited role in younger children and seldom significantly changes management albeit making additional diagnoses.
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