Diagnostic imaging in pediatric trauma

In the head and neck, the futility of skull radiography is again reemphasized as a poorer predictor of intracranial injury than is a neurologic examination, though controversy continues as to which neurologic criteria should be the ones leading to a cranial computed tomography scan. Understanding the anatomic variations in the radiography of the cervical spine in small infants and children can help avoid overdiagnosis in this group and can obviate the need for additional unwarranted computed tomography studies and undue clinical concern. Magnetic resonance imaging can show anatomically exquisite portrayals of growing skull fractures for neurosurgical planning, but its routine use for imaging the cervical cord in shaken, abused infants without clinical abnormality appears unwarranted. Within the chest, the radiograph remains a highly accurate and low cost cornerstone in traumatized patients. The use of ultrasound imaging to detect pleural fluid is being investigated and has been found to be accurate but cannot compare to all of the information gleaned from the radiograph. The pericardium is clearly an exception. Abdominal trauma in children is triaged vastly differently from that of adults. Imaging of adults looks for signs to diagnose significant bleeding and need for operation, while pediatric trauma imaging has its greatest effect in reducing the intensity of care. Administration of oral contrast has not been very effective in aiding diagnosis of hollow visceral perforations and is being used less in blunt abdominal trauma computed tomography. Children with microscopic hematuria and no evidence of multiple system trauma seem to be helped little by imaging. The utility of finding and extracting subcutaneous foreign material, usually in extremities, by ultrasound imaging remains controversial. Experience, equipment, and effort all seem to play a role.