The utility of computed tomography as a screening tool for the evaluation of pediatric blunt chest trauma.

Troy A. Markel, Rajiv Kumar, Nicholas A. Koontz, L. R. Scherer, Kimberly E. Applegate

Research output: Contribution to journalArticle

Abstract

BACKGROUND: There is a growing concern that computed tomography (CT) is being unnecessarily overused for the evaluation of pediatric patients. The purpose of this study was to analyze the trends and utility of chest CT use compared with chest X-ray (CXR) for the evaluation of children with blunt chest trauma. METHODS: A 4-year retrospective review was performed for pediatric patients who underwent chest CT within 24 hours of sustaining blunt trauma at a Level-I trauma center. Trends in the use of CT and CXR were documented, and results of radiology reports were analyzed and compared with clinical outcomes. RESULTS: Three hundred thirty-three children, mean age 11 years, had chest CTs, increasing from 5.5% in 2001-2002 to 10.5% in 2004-2005 (p < 0.001). Conversely, in those children who underwent chest CT, the rate of initial CXR use decreased from 84% to 56% during the same period (p < 0.001). Twenty percent of chest CTs had significant positive findings. Six patients underwent emergency surgery for cardiac or arterial injuries, and all demonstrated abnormal findings on CXR or CT scout imaging. When compared with the CT, only 5% of initial CXRs falsely reported normal findings that may have altered management. CONCLUSIONS: CT use in children has increased rapidly for the initial evaluation of chest trauma, whereas CXR use has decreased. Despite this trend, CXR remains an acceptable screening tool to analyze which patients may require CT evaluation. A multidisciplinary approach is warranted to develop guidelines that standardize the use of CT and thereby decreases unnecessary radiation exposure to pediatric patients.

Original languageEnglish
Pages (from-to)23-28
Number of pages6
JournalJournal of Trauma - Injury, Infection and Critical Care
Volume67
Issue number1
StatePublished - Jul 2009

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Thorax
Tomography
Pediatrics
Wounds and Injuries
X-Rays
X Ray Computed Tomography
Trauma Centers
Radiology
Thoracic Surgery
Emergencies
Guidelines

ASJC Scopus subject areas

  • Medicine(all)

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The utility of computed tomography as a screening tool for the evaluation of pediatric blunt chest trauma. / Markel, Troy A.; Kumar, Rajiv; Koontz, Nicholas A.; Scherer, L. R.; Applegate, Kimberly E.

In: Journal of Trauma - Injury, Infection and Critical Care, Vol. 67, No. 1, 07.2009, p. 23-28.

Research output: Contribution to journalArticle

Markel, Troy A. ; Kumar, Rajiv ; Koontz, Nicholas A. ; Scherer, L. R. ; Applegate, Kimberly E. / The utility of computed tomography as a screening tool for the evaluation of pediatric blunt chest trauma. In: Journal of Trauma - Injury, Infection and Critical Care. 2009 ; Vol. 67, No. 1. pp. 23-28.
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