Imaging Pathways in Pediatric Thoracic Trauma: FAST-First Triage and Selective CT Escalation in Clinical Practice

Area of Science:

• Pediatric Emergency Medicine
• Radiology
• Trauma Surgery

Background:

• Pediatric thoracic trauma management lacks standardized imaging pathways.
• Prompt stabilization and timely imaging are crucial for pediatric thoracic trauma.
• Current imaging escalation triggers are not well-defined.

Purpose of the Study:

• Analyze current imaging pathways for pediatric thoracic trauma.
• Develop an escalation framework based on injury mechanism, clinical severity, and ultrasound findings.
• Standardize imaging protocols in pediatric thoracic trauma.

Main Methods:

• Retrospective cohort study of 66 children with thoracic trauma.
• Analysis of imaging sequences: FAST, CXR, CT, MRI/CTA.
• Comparison of imaging patterns between bony and non-bony injuries.
• Statistical analysis using Fisher's exact and Mann-Whitney U tests.

Main Results:

• FAST was universally applied but infrequently positive.
• Imaging pathways were heterogeneous but structured (FAST with CXR, with or without CT).
• CT escalation correlated with bony injuries, higher acuity (ICU admission), and longer stays.
• FAST effectively identified ICU-level trajectories; CT captured bony injury patterns.

Conclusions:

• Pediatric thoracic trauma imaging acts as a selective escalation system.
• FAST serves as a universal bedside triage tool.
• CT functions as a severity gate, linked to injury patterns and acuity.
• Clarifying imaging logic can enhance standardization and radiation protection.