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Whole-body PET/MRI of Pediatric Patients: The Details That Matter
Published on: December 19, 2017
Is the rate of chest computed tomography different between adult and pediatric Level 1 trauma centers?
Insights
Pediatric trauma centers utilize chest computed tomography (CCT) less often than adult trauma centers for children with blunt thoracic trauma. This suggests adult centers may overuse CCT, increasing radiation exposure risks for pediatric patients.
Area of Science:
- Pediatric Trauma Surgery
- Radiology in Pediatrics
- Thoracic Trauma Management
Background:
- Children with blunt thoracic trauma receive care at pediatric and adult trauma centers.
- Minimizing radiation exposure is crucial for pediatric patients.
- Chest computed tomography (CCT) rarely changes management in children with normal chest radiographs (CXR).
Purpose of the Study:
- To test the hypothesis that adult trauma centers overutilize CCT in children with suspected blunt thoracic trauma.
- To compare CCT utilization rates between pediatric and adult trauma centers for pediatric blunt thoracic trauma cases.
Main Methods:
- Retrospective review of the Pennsylvania Trauma System Foundation database (2019-2023).
- Comparison of children (<15 years) treated at Level 1 pediatric regional trauma centers (PTC) versus adult Level 1 trauma centers (ATC).
- Identification of interventions using ICD-10 procedure codes; exclusion of transfers.
Main Results:
- Lower CCT rates observed in PTCs (10.94%) compared to ATCs (19.18%) across all ages (p<0.0001).
- PTCs had higher injury severity scores (ISS) but lower CCT rates, even in shorter stays (<3 days).
- PTCs showed higher thoracostomy tube placement rates (10.75% vs. 1.48%, p=0.002) without differences in other critical interventions.
Conclusions:
- Pediatric trauma centers demonstrate lower CCT utilization for pediatric blunt thoracic trauma compared to adult centers.
- Findings support the hypothesis of CCT overutilization in adult trauma centers for pediatric blunt thoracic trauma.
- Reduced CCT use in pediatric centers, even for less severe cases, aligns with radiation risk minimization principles.
Background:
Injured children receive trauma care at both children's hospitals and adult trauma centers. The established risk that radiation poses to children mandates minimizing exposure whenever possible. Several studies show chest computed tomography (CCT) rarely alters management of children with suspected thoracic trauma when the chest radiograph (CXR) is normal. We hypothesize that adult trauma centers overutilize CCT for children with suspected blunt thoracic trauma.
Methods:
We conducted a retrospective review of the Pennsylvania Trauma System Foundation database for all children below 15 years old sustaining blunt trauma between 2019 and 2023. Patients who presented to Level 1 pediatric regional trauma centers (PTC) (n=3) were compared with adult Level 1 trauma centers (ATC) (n=10); transfers were excluded. ICD-10 procedure codes were used to identify patients with any interventions on the chest.
Results:
The query identified 1,241 qualified patients, 850 treated at PTCs and 391 at ATCs. PTC patients were younger with a higher injury severity score (ISS). There was a decreased rate of CCT at PTCs (10.94% vs. 19.18%, p<0.0001). Subgroup analysis revealed a difference in CCT rate for ages 10-14 (18.33% vs. 35.97%, p<0.0001). PTCs also had a higher rate of thoracostomy tube placement (10.75% vs. 1.48%, p=0.002), but there were no differences in intubation, cardiopulmonary arrest, thoracotomy, or sternotomy. Subgroup analysis of patients with a length of stay <3 days showed no differences in age, ISS, or interventions; however, the rate of CCT was higher at ATCs (6.58% vs. 25.77%, p<0.0001).
Conclusions:
CCT rates were lower across all age groups in the PTC cohort despite PTCs having a higher ISS score. Interestingly, there continued to be decreased CCT use at PTCs for children who were admitted for less than 3 days. Our findings support the hypothesis that adult trauma centers overutilize CCT in children suspected of blunt thoracic trauma. (J Trauma Acute Care Surg 2026;00:000-000. Copyright © 2026 Wolters Kluwer Health, Inc. All rights reserved.).
Level Of Evidence:
Level III.
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