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The Clinical Value of Computed Tomography of Facial Bone Injuries in Pediatric Trauma Patients
M Virginia Butchy1, John Williamson1, Johanna Lou1
1Department of Surgery, Cooper University Hospital, Camden, NJ, USA.
Insights
Computed tomography of the head (CTH) can effectively screen for facial fractures in pediatric trauma patients. A negative CTH can avoid unnecessary facial bone CT (CTF), reducing radiation exposure and healthcare costs.
Area of Science:
- Pediatric Traumatology
- Radiology
- Emergency Medicine
Background:
- Head trauma is a major cause of morbidity and mortality in children.
- Guidelines exist for head CT (CTH) but not facial CT (CTF) in pediatric head trauma.
- Identifying which pediatric patients benefit from CTF is unclear.
Purpose of the Study:
- To determine which pediatric head trauma patients clinically benefit from the addition of a facial CT (CTF).
Main Methods:
- Retrospective review of pediatric trauma patients undergoing CTH and/or CTF from 2016-2021.
- Data collected included demographics, injury mechanism, consultations, and interventions.
- Analysis focused on fracture identification and need for intervention.
Main Results:
- Of 2117 patients, 173 received both CTH and CTF.
- Patients receiving both were older, had high-velocity trauma, and longer hospital stays.
- 42.2% of CTF scans showed no fractures; only 5.7% of fractures identified required intervention, primarily mandibular.
Conclusions:
- CTH can serve as a screening tool for facial fractures, potentially avoiding CTF.
- CTF identifies more fractures, but few require intervention.
- CTF should be reserved for a select group of pediatric trauma patients with facial injuries.
Background:
Head trauma is responsible for significant morbidity and mortality in the pediatric trauma population. There are validated guidelines which indicate the necessity for computed tomography of the head (CTH), but the indication for a dedicated CT of the facial bones (CTF) is less clear. We sought to identify our population of head trauma patients who would clinically benefit from the addition of CTF.
Methods:
Using the electronic medical record, pediatric trauma patients who underwent CTH and/or CTF from 2016 to 2021 were identified. We collected information on demographics, traumatic mechanism, subspecialty consultation, and operative and procedural interventions.
Results:
2117 pediatric patients were evaluated. A total of 372 patients received CTH and 173 patients received both CTH + CTF. Patients with CTH + CTF were older (P < 0.001), involved in high-velocity blunt trauma (P < 0.001), and had a longer length of stay (P < 0.001). There were no fractures identified in 73 (42.2%) patients with both CTH + CTF. Of patients with fractures, there were 204 fractures identified and 73.0% (149/204) of fractures were seen on both the CTH + CTF. There were 19.6% (40/204) read only on CTF and 10 patients (5.7%) had a fracture requiring intervention. 8 of the 10 fractures requiring operative intervention were mandibular bone fractures.
Discussion:
Computed tomography of the head can be used as a screening tool for facial fractures. A negative CTH can eliminate the need for additional radiation from a CTF. Computed tomography of the facial bones will identify more fractures, but few requiring intervention. We suggest that CTF be limited to a subset of pediatric trauma patients with facial injury.
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