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Imaging findings in penetrating injuries in the paediatric population - Experience from a major trauma Centre
Sara Ffrench-Constant1, Chris Aylwin1, Nicola Batrick1
1Imperial College NHS Trust, St Mary's Hospital, London W2 1NY, United Kingdom.
Insights
Penetrating injuries in adolescents are most common in the gluteal region, but anterior abdominal wall and junctional zone injuries carry higher risks. Dual phase CT is crucial for identifying serious vascular or rectal injuries in gluteal trauma.
Area of Science:
- Trauma Imaging
- Pediatric Radiology
- Emergency Medicine
Background:
- Penetrating injuries in children require accurate assessment for optimal management.
- Specific anatomical locations like the gluteal region, anterior abdominal wall, and junctional zones present unique diagnostic challenges.
Purpose of the Study:
- To evaluate common injury sites and imaging findings in pediatric penetrating trauma.
- To identify areas of diagnostic uncertainty and discrepancies between imaging and surgical outcomes.
- To enhance trauma reporting by focusing on critical review areas.
Main Methods:
- Retrospective observational study.
- Inclusion of all pediatric emergency department admissions for penetrating injuries from 2015-2019.
- Review of dual phase CT findings and correlation with surgical outcomes.
Main Results:
- Gluteal penetrating injuries are the most frequent (over 1/3 of cases), often superficial but with a 15% risk of serious vascular or rectal injury requiring intervention.
- Anterior abdominal wall and junctional zone injuries are less common but associated with higher morbidity (43% solid organ/bowel injury) and increased diagnostic uncertainty.
- Dual phase CT demonstrated significant injuries in a subset of gluteal trauma cases.
Conclusions:
- While gluteal injuries are common, vigilance for life-threatening vascular or rectal complications is essential, necessitating dual phase CT or direct visualization.
- Anterior abdominal wall and junctional zone injuries, though less frequent, present greater morbidity and diagnostic challenges.
- Utilizing specific imaging findings can improve diagnostic accuracy and reduce discrepancies in trauma reporting.
Objective:
The primary objective of this study is to assess common sites of injury and the associated imaging findings in penetrating injuries. We pay particular attention to gluteal, anterior abdominal wall and junctional zone injuries. The aim is to highlight areas of diagnostic uncertainty and discrepancy between imaging and surgical findings, to improve review areas in trauma reporting.
Methods:
A retrospective, observational study reviewing all paediatric admissions to the emergency department of a major trauma Centre with a penetrating injury, from 2015 to 2019.
Results:
Gluteal penetrating injuries are by far the most commonly sustained injury in the adolescent population, making up over 1/3 of cases. The vast majority of these cases sustained superficial injuries or shallow intramuscular haematomas, however in a small group (15%), serious vascular or rectal injuries were demonstrated on dual phase CT, requiring emergent surgical or endovascular treatment. Penetrating injuries to the anterior abdominal wall and junctional zone are less common but are associated with higher morbidity, with 43% of cases demonstrating solid organ or bowel injury. These cases also lead to an increased degree of diagnostic uncertainty.
Conclusion:
Gluteal injuries are common and although the overall morbidity of these cases is low, these patients are at risk of serious and life threatening consequences such as vascular and rectal injury and it is imperative that these complications are considered and ruled out via dual phase CT or direct visualization. Anterior abdominal wall and junctional zone injuries are less common, but lead to greater morbidity and also greater diagnostic uncertainty. The use of other salient findings as described in this report can aid diagnostic accuracy and reduce discrepancies.
