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Updated: Jun 26, 2026
Whole-body PET/MRI of Pediatric Patients: The Details That Matter
Published on: December 19, 2017
Development of a novel clinical decision support tool for determining the need for whole-body computed tomography in
Enes Çay1, Gül Pamukçu Günaydın2,3, Çağdaş Yıldırım4,5
1Department of Emergency Medicine, Çankırı State Hospital, Kırkevler, Kastamonu Cd. No:236, 18100, Çankırı, Merkez, Türkiye.
Insights
A new WHOLE score helps identify pediatric trauma patients unlikely to need whole body computed tomography (WBCT), potentially reducing radiation exposure. This tool supports clinicians in withholding WBCT for low-risk children, enhancing diagnostic safety.
Area of Science:
- Pediatric Emergency Medicine
- Radiology
- Trauma Surgery
Background:
- Whole body computed tomography (WBCT) is crucial for pediatric trauma assessment but exposes children to significant ionizing radiation.
- Current guidelines lack clarity on WBCT necessity, leading to overuse and practice variability in emergency departments.
- A need exists for tools to guide selective WBCT use, complementing existing imaging frameworks.
Purpose of the Study:
- To develop and validate a clinical decision support tool, the WHOLE score, to identify pediatric trauma patients at low risk for multi-region injuries.
- To aid emergency physicians in making informed decisions about withholding WBCT, thereby reducing unnecessary radiation exposure.
- To improve the risk-based selection of pediatric trauma patients who would benefit from WBCT.
Main Methods:
- Retrospective observational study of 407 pediatric trauma patients (<18 years) who underwent WBCT.
- Identified predictors of multi-region injury using multivariable logistic regression and ROC analysis.
- Developed the WHOLE score based on independent predictors: age, tachycardia, hypoxia, physical exam findings, and AST levels.
Main Results:
- The WHOLE score incorporates age (≥133 months), tachycardia, hypoxia, specific physical exam findings, and AST (≥50 U/L).
- The score demonstrated good discrimination for multi-region injuries (AUC 0.84).
- A WHOLE score cutoff of ≥2 points achieved 96.7% sensitivity and 94.8% negative predictive value for detecting multi-region injuries.
Conclusions:
- The WHOLE score is a simple tool to identify low-risk pediatric trauma patients who may not require WBCT.
- It functions as a rule-out tool, supporting decisions to forego WBCT in selected cases and potentially reducing radiation exposure.
- External prospective validation is necessary before widespread clinical implementation of the WHOLE score.
Background:
Whole body computed tomography (WBCT) is widely used in the initial assessment of pediatric trauma patients to rapidly identify injuries; however, its routine use exposes children to substantial ionizing radiation. Clear guidance on which pediatric trauma patients truly benefit from WBCT is lacking, leading to practice variability and potential overuse in emergency departments. The proposed score is intended to complement existing pediatric imaging decision frameworks that emphasize selective and risk-based use of computed tomography.
Methods:
This retrospective, single-center observational study included trauma patients under 18 years of age who underwent WBCT in a tertiary pediatric trauma center between June 2021 and June 2022. The primary outcome was the presence of traumatic injuries involving ≥ 2 anatomical regions on WBCT not necessarily the clinical need for WBCT. Candidate predictors were identified from the literature and clinical practice and evaluated using multivariable logistic regression. Continuous variables were dichotomized based on receiver operating characteristics (ROC) analysis. Independent predictors were used to develop a clinical decision support tool, the WHOLE score. Model performance was assessed using ROC analysis and diagnostic accuracy metrics.
Results:
A total of 407 pediatric trauma patients who underwent WBCT were included; 37.6% (n = 153), had injuries involving two or more anatomical regions. Independent predictors of multi-region injury were age ≥ 133 months, tachycardia, hypoxia, positive physical examination findings in the head, thoracic, pelvic, or lower extremity regions, and aspartate aminotransferase (AST) ≥ 50 U/L. These variables were incorporated into the WHOLE score (range 0-8). The WHOLE score demonstrated good discrimination (AUC 0.84; 95% CI 0.80-0.88). Using a cut-off of ≥ 2 points, sensitivity was 96.7% (CI 92.5-98.9) and NPV was 94.8% for detecting multi-region injuries.
Conclusions:
The WHOLE score is a simple clinical decision support tool designed to identify pediatric trauma patients at low risk for multi-region injuries, thereby supporting emergency physicians in safely withholding WBCT in appropriately selected cases. The score functions as a rule-out tool: a low score (0-1) may support a decision to forego WBCT, whereas a high score does not independently mandate it. By reducing unnecessary WBCT in low-risk patients, the score has the potential to decrease radiation exposure while maintaining diagnostic safety. This is a preliminary single-center derivation study, and external prospective validation is required before routine clinical implementation.
Trial Registration:
The study protocol was registered retrospectively at clinicaltrials.gov (Clinical Trials Identifier: NCT07411235, Date:11/02/2026).
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