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
N1 - Publisher Copyright:
© 2017 Elsevier Inc.
PY - 2017/12
Y1 - 2017/12
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
SN - 0022-3468
VL - 52
SP - 2031
EP - 2037
JO - Journal of pediatric surgery
JF - Journal of pediatric surgery
IS - 12
ER -