Limiting thoracic CT: A rule for use during initial pediatric trauma evaluation

Caroline Q. Stephens, Meredith C. Boulos, Christopher R. Connelly, Arvin Gee, Mubeen Jafri, Sanjay Krishnaswami

Research output: Research - peer-reviewArticle

Abstract

Background: Despite increases in imaging guidelines for other body-regions during initial trauma assessment and the demonstrated utility of chest radiographs (CXR), guidelines for use of thoracic computed-tomography (TCT) are lacking. We hypothesized that TCT utilization had not decreased relative to other protocolized CTs, and mechanism and CXR could together predict significant injury independent of TCT. Methods: We performed a retrospective review of blunt trauma patients ≤. 18 y.o. (2007-2015) at two level-1 trauma centers who received chest imaging. Baseline characteristics and incidences of body region-specific CT were compared. Injury mechanism, intrathoracic pathology, and interventions among other data were examined (significance: p. <. 0.05). Results: Although other body-region CT incidence decreased (p. <. 0.05), TCT incidence did not change (p = 0.65). Of the 2951 patients, 567 had both CXR and TCT, 933 received TCT-only, and 1451 had CXR-only. TCT altered management in 17 patients: 2 operations, 1 stent-placement, 1 medical management, 9 thoracostomy tube placements, and 4 negative diagnostic workups. All clinically significant changes were predicted by vehicle-related mechanism and abnormal CXR findings. Conclusions: TCT utilization has not decreased over time. All meaningful interventions were predicted by CXR and mechanism of injury. We propose a rule, for prospective validation, reserving TCT for patients with abnormal CXR findings and severe vehicle-related trauma. Level of evidence: Diagnostic study, Level III.

LanguageEnglish (US)
JournalJournal of Pediatric Surgery
DOIs
StateAccepted/In press - 2017

Fingerprint

Thorax
Pediatrics
Wounds and Injuries
Tomography
Body Regions
Incidence
Guidelines
Thoracostomy
Thoracic Injuries
Trauma Centers
Stents
Pathology

Keywords

  • Chest X-ray
  • Pediatric blunt trauma
  • Thoracic CT
  • Thoracic trauma

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Surgery

Cite this

Limiting thoracic CT : A rule for use during initial pediatric trauma evaluation. / Stephens, Caroline Q.; Boulos, Meredith C.; Connelly, Christopher R.; Gee, Arvin; Jafri, Mubeen; Krishnaswami, Sanjay.

In: Journal of Pediatric Surgery, 2017.

Research output: Research - peer-reviewArticle

Stephens, Caroline Q. ; Boulos, Meredith C. ; Connelly, Christopher R. ; Gee, Arvin ; Jafri, Mubeen ; Krishnaswami, Sanjay. / Limiting thoracic CT : A rule for use during initial pediatric trauma evaluation. In: Journal of Pediatric Surgery. 2017
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