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.
| Original language | English (US) |
|---|---|
| Journal | Journal of Pediatric Surgery |
| DOIs | |
| State | Accepted/In press - 2017 |
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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: Contribution to journal › Article
}
TY - JOUR
T1 - Limiting thoracic CT
T2 - A rule for use during initial pediatric trauma evaluation
AU - Stephens, Caroline Q.
AU - Boulos, Meredith C.
AU - Connelly, Christopher R.
AU - Gee, Arvin
AU - Jafri, Mubeen
AU - Krishnaswami, Sanjay
PY - 2017
Y1 - 2017
N2 - 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.
AB - 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.
KW - Chest X-ray
KW - Pediatric blunt trauma
KW - Thoracic CT
KW - Thoracic trauma
UR - http://www.scopus.com/inward/record.url?scp=85029473337&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85029473337&partnerID=8YFLogxK
U2 - 10.1016/j.jpedsurg.2017.08.039
DO - 10.1016/j.jpedsurg.2017.08.039
M3 - Article
C2 - 28927984
AN - SCOPUS:85029473337
JO - Journal of Pediatric Surgery
JF - Journal of Pediatric Surgery
SN - 0022-3468
ER -