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J Pediatr Surg ; 52(12): 2031-2037, 2017 Dec.
Article in English | MEDLINE | ID: mdl-28927984

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.


Subject(s)
Thoracic Injuries/diagnostic imaging , Wounds, Nonpenetrating/diagnostic imaging , Adolescent , Child , Female , Humans , Infant , Lung Injury/diagnostic imaging , Male , Physical Examination , Retrospective Studies , Thoracic Injuries/classification , Thoracic Injuries/surgery , Tomography, X-Ray Computed , Trauma Centers , Wounds, Nonpenetrating/classification , Wounds, Nonpenetrating/surgery
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