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Clinical Predictors of Major Intrathoracic Injury in Pediatric Blunt Trauma

Stephen M Gunnink1, Alysa M Butz, Jordan Griep

  • 1From the Department of Emergency Medicine, Corewell Health Helen DeVos Children's Hospital, Grand Rapids, MI.

Pediatric Emergency Care
|December 29, 2023
PubMed

Insights

Pediatric blunt thoracic trauma (BTT) patients over 15 with chest pain, tachycardia, or abnormal auscultation have a higher risk of major intrathoracic injuries. Thoracic CT may benefit these high-risk pediatric BTT patients.

Area of Science:

  • Medical Imaging
  • Pediatric Traumatology
  • Thoracic Surgery

Background:

  • Blunt trauma is a leading cause of death in children.
  • No current clinical decision tools exist for imaging in pediatric blunt thoracic trauma (BTT).
  • Chest X-ray (CXR) may miss significant intrathoracic injuries in pediatric BTT patients.

Purpose of the Study:

  • To determine the rate of missed major intrathoracic injuries on CXR in pediatric BTT patients.
  • To identify clinical risk factors associated with major intrathoracic injuries.
  • To develop a decision tool for computed tomography (CT) use in pediatric BTT.

Main Methods:

  • Retrospective single-center study of pediatric patients with BTT.
  • Inclusion criteria: age, blunt trauma, CXR, and thoracic CT within 24 hours.
  • Logistic regression analysis of 84 variables to identify predictors of major injury.

Main Results:

  • CXR missed injuries in 180 patients (48.3%); 20 patients (5.4%) had major injuries missed on CXR.
  • Risk factors for major thoracic injuries included older age (OR 1.125), chest pain (OR 4.907), abnormal chest auscultation (OR 3.564), and tachycardia (OR 2.876).
  • A model using these four variables achieved an area under the curve of 0.7903.

Conclusions:

  • Pediatric BTT patients over 15 years old with chest pain, abnormal chest auscultation, or tachycardia are at increased risk for major intrathoracic injuries.
  • Thoracic CT may be beneficial for evaluating these high-risk pediatric patients.
  • This study provides a foundation for a clinical decision tool to guide CT use in pediatric BTT.
Abstract

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