Mechanism of injury alone is not justified as the sole indication for computed tomographic imaging in blunt pediatric trauma

Hunter B. Moore, Leonard Wade Faulk, Ernest E. Moore, Fredric Pierraci, Clay Cothren Burlew, Courtenay M. Holscher, Carlton C. Barnett, Gregory Jurkovich, Denis D. Bensard

Research output: Contribution to journalArticle

14 Citations (Scopus)

Abstract

BACKGROUND: The liberal use of computed tomographic (CT) scanning during the evaluation of injured children has increased their exposure to the risks of ionizing radiation. We hypothesized that CT imaging performed for mechanism of injury alone is unnecessary and that serious or life-threatening injury is rarely identified. METHODS: All pediatric blunt trauma team evaluations (age G 15 years) at a pediatric Level 2 trauma center over 72 months were reviewed. CT findings in patients with normal Glasgow Coma Scale (GCS) score, vital signs (VS), and physical examination (PE) (Group 1)were comparedwithGroup 2 (GCS score G 15),Group 3 (abnormalVS/PE), andGroup 4 (abnormalGCS score, VS/PE). Variables associated with any positive finding were entered into a multiple logistic regression model to assess for independent contributions. Each patient's total effective radiation dose fromCT scans inmillisievertswas calculated using an ageadjusted scale. RESULTS: A total 174 children met trauma team activation criteria (mean [SD] age, 7 [5] years; 63% male; mean [SD] Injury Severity Score [ISS], 10 [10]). A total of 153 (88%) were imaged by CT (1, 54 of 66; 2, 25 of 25; 3, 49 of 57; 4, 25 of 26). No patient in Group 1 had a serious finding on CT compared with Group 2 (17 of 77), 3 (25 of 111), and 4 (18 of 72). Mortality was 4%. Radiation dose (mSv) from CT was not different among the groups (1, 17 [14]; 2, 29 [13]; 3, 21 [16]; 4, 27 [17]). By univariate analysis, GCS score of less than 15 ( p < 0.01) and respiratory rate of greater than 30 ( p = 0.09) were associated with a positive CT finding. By logistic regression analysis, GCS score of less than 15 remained the only variable associated significantly with a positive finding (odds ratio, 6.7; 95% confidence interval, 3-14; p < 0.01). CONCLUSION: In children imaged based only on mechanism, no patient had a serious positive finding but was subjected to radiation doses associated with an increased risk of future malignancy. The use of CT imaging in injured children in the absence of a physiologic or anatomic abnormality does not seemto be justified.

Original languageEnglish (US)
Pages (from-to)995-1001
Number of pages7
JournalJournal of Trauma and Acute Care Surgery
Volume75
Issue number6
DOIs
StatePublished - Dec 1 2013
Externally publishedYes

Fingerprint

Glasgow Coma Scale
Pediatrics
Physical Examination
Vital Signs
Logistic Models
Wounds and Injuries
Radiation
Injury Severity Score
Trauma Centers
Respiratory Rate
Ionizing Radiation
Odds Ratio
Regression Analysis
Confidence Intervals
Mortality
Neoplasms

Keywords

  • Blunt trauma
  • Children
  • CT imaging
  • Mechanism of injury
  • Radiation exposure

ASJC Scopus subject areas

  • Surgery
  • Critical Care and Intensive Care Medicine

Cite this

Mechanism of injury alone is not justified as the sole indication for computed tomographic imaging in blunt pediatric trauma. / Moore, Hunter B.; Faulk, Leonard Wade; Moore, Ernest E.; Pierraci, Fredric; Burlew, Clay Cothren; Holscher, Courtenay M.; Barnett, Carlton C.; Jurkovich, Gregory; Bensard, Denis D.

In: Journal of Trauma and Acute Care Surgery, Vol. 75, No. 6, 01.12.2013, p. 995-1001.

Research output: Contribution to journalArticle

Moore, Hunter B. ; Faulk, Leonard Wade ; Moore, Ernest E. ; Pierraci, Fredric ; Burlew, Clay Cothren ; Holscher, Courtenay M. ; Barnett, Carlton C. ; Jurkovich, Gregory ; Bensard, Denis D. / Mechanism of injury alone is not justified as the sole indication for computed tomographic imaging in blunt pediatric trauma. In: Journal of Trauma and Acute Care Surgery. 2013 ; Vol. 75, No. 6. pp. 995-1001.
@article{dba585efff3844aabc92a8c22cd79087,
title = "Mechanism of injury alone is not justified as the sole indication for computed tomographic imaging in blunt pediatric trauma",
abstract = "BACKGROUND: The liberal use of computed tomographic (CT) scanning during the evaluation of injured children has increased their exposure to the risks of ionizing radiation. We hypothesized that CT imaging performed for mechanism of injury alone is unnecessary and that serious or life-threatening injury is rarely identified. METHODS: All pediatric blunt trauma team evaluations (age G 15 years) at a pediatric Level 2 trauma center over 72 months were reviewed. CT findings in patients with normal Glasgow Coma Scale (GCS) score, vital signs (VS), and physical examination (PE) (Group 1)were comparedwithGroup 2 (GCS score G 15),Group 3 (abnormalVS/PE), andGroup 4 (abnormalGCS score, VS/PE). Variables associated with any positive finding were entered into a multiple logistic regression model to assess for independent contributions. Each patient's total effective radiation dose fromCT scans inmillisievertswas calculated using an ageadjusted scale. RESULTS: A total 174 children met trauma team activation criteria (mean [SD] age, 7 [5] years; 63{\%} male; mean [SD] Injury Severity Score [ISS], 10 [10]). A total of 153 (88{\%}) were imaged by CT (1, 54 of 66; 2, 25 of 25; 3, 49 of 57; 4, 25 of 26). No patient in Group 1 had a serious finding on CT compared with Group 2 (17 of 77), 3 (25 of 111), and 4 (18 of 72). Mortality was 4{\%}. Radiation dose (mSv) from CT was not different among the groups (1, 17 [14]; 2, 29 [13]; 3, 21 [16]; 4, 27 [17]). By univariate analysis, GCS score of less than 15 ( p < 0.01) and respiratory rate of greater than 30 ( p = 0.09) were associated with a positive CT finding. By logistic regression analysis, GCS score of less than 15 remained the only variable associated significantly with a positive finding (odds ratio, 6.7; 95{\%} confidence interval, 3-14; p < 0.01). CONCLUSION: In children imaged based only on mechanism, no patient had a serious positive finding but was subjected to radiation doses associated with an increased risk of future malignancy. The use of CT imaging in injured children in the absence of a physiologic or anatomic abnormality does not seemto be justified.",
keywords = "Blunt trauma, Children, CT imaging, Mechanism of injury, Radiation exposure",
author = "Moore, {Hunter B.} and Faulk, {Leonard Wade} and Moore, {Ernest E.} and Fredric Pierraci and Burlew, {Clay Cothren} and Holscher, {Courtenay M.} and Barnett, {Carlton C.} and Gregory Jurkovich and Bensard, {Denis D.}",
year = "2013",
month = "12",
day = "1",
doi = "10.1097/TA.0b013e3182ab065b",
language = "English (US)",
volume = "75",
pages = "995--1001",
journal = "Journal of Trauma and Acute Care Surgery",
issn = "2163-0755",
publisher = "Lippincott Williams and Wilkins",
number = "6",

}

TY - JOUR

T1 - Mechanism of injury alone is not justified as the sole indication for computed tomographic imaging in blunt pediatric trauma

AU - Moore, Hunter B.

AU - Faulk, Leonard Wade

AU - Moore, Ernest E.

AU - Pierraci, Fredric

AU - Burlew, Clay Cothren

AU - Holscher, Courtenay M.

AU - Barnett, Carlton C.

AU - Jurkovich, Gregory

AU - Bensard, Denis D.

PY - 2013/12/1

Y1 - 2013/12/1

N2 - BACKGROUND: The liberal use of computed tomographic (CT) scanning during the evaluation of injured children has increased their exposure to the risks of ionizing radiation. We hypothesized that CT imaging performed for mechanism of injury alone is unnecessary and that serious or life-threatening injury is rarely identified. METHODS: All pediatric blunt trauma team evaluations (age G 15 years) at a pediatric Level 2 trauma center over 72 months were reviewed. CT findings in patients with normal Glasgow Coma Scale (GCS) score, vital signs (VS), and physical examination (PE) (Group 1)were comparedwithGroup 2 (GCS score G 15),Group 3 (abnormalVS/PE), andGroup 4 (abnormalGCS score, VS/PE). Variables associated with any positive finding were entered into a multiple logistic regression model to assess for independent contributions. Each patient's total effective radiation dose fromCT scans inmillisievertswas calculated using an ageadjusted scale. RESULTS: A total 174 children met trauma team activation criteria (mean [SD] age, 7 [5] years; 63% male; mean [SD] Injury Severity Score [ISS], 10 [10]). A total of 153 (88%) were imaged by CT (1, 54 of 66; 2, 25 of 25; 3, 49 of 57; 4, 25 of 26). No patient in Group 1 had a serious finding on CT compared with Group 2 (17 of 77), 3 (25 of 111), and 4 (18 of 72). Mortality was 4%. Radiation dose (mSv) from CT was not different among the groups (1, 17 [14]; 2, 29 [13]; 3, 21 [16]; 4, 27 [17]). By univariate analysis, GCS score of less than 15 ( p < 0.01) and respiratory rate of greater than 30 ( p = 0.09) were associated with a positive CT finding. By logistic regression analysis, GCS score of less than 15 remained the only variable associated significantly with a positive finding (odds ratio, 6.7; 95% confidence interval, 3-14; p < 0.01). CONCLUSION: In children imaged based only on mechanism, no patient had a serious positive finding but was subjected to radiation doses associated with an increased risk of future malignancy. The use of CT imaging in injured children in the absence of a physiologic or anatomic abnormality does not seemto be justified.

AB - BACKGROUND: The liberal use of computed tomographic (CT) scanning during the evaluation of injured children has increased their exposure to the risks of ionizing radiation. We hypothesized that CT imaging performed for mechanism of injury alone is unnecessary and that serious or life-threatening injury is rarely identified. METHODS: All pediatric blunt trauma team evaluations (age G 15 years) at a pediatric Level 2 trauma center over 72 months were reviewed. CT findings in patients with normal Glasgow Coma Scale (GCS) score, vital signs (VS), and physical examination (PE) (Group 1)were comparedwithGroup 2 (GCS score G 15),Group 3 (abnormalVS/PE), andGroup 4 (abnormalGCS score, VS/PE). Variables associated with any positive finding were entered into a multiple logistic regression model to assess for independent contributions. Each patient's total effective radiation dose fromCT scans inmillisievertswas calculated using an ageadjusted scale. RESULTS: A total 174 children met trauma team activation criteria (mean [SD] age, 7 [5] years; 63% male; mean [SD] Injury Severity Score [ISS], 10 [10]). A total of 153 (88%) were imaged by CT (1, 54 of 66; 2, 25 of 25; 3, 49 of 57; 4, 25 of 26). No patient in Group 1 had a serious finding on CT compared with Group 2 (17 of 77), 3 (25 of 111), and 4 (18 of 72). Mortality was 4%. Radiation dose (mSv) from CT was not different among the groups (1, 17 [14]; 2, 29 [13]; 3, 21 [16]; 4, 27 [17]). By univariate analysis, GCS score of less than 15 ( p < 0.01) and respiratory rate of greater than 30 ( p = 0.09) were associated with a positive CT finding. By logistic regression analysis, GCS score of less than 15 remained the only variable associated significantly with a positive finding (odds ratio, 6.7; 95% confidence interval, 3-14; p < 0.01). CONCLUSION: In children imaged based only on mechanism, no patient had a serious positive finding but was subjected to radiation doses associated with an increased risk of future malignancy. The use of CT imaging in injured children in the absence of a physiologic or anatomic abnormality does not seemto be justified.

KW - Blunt trauma

KW - Children

KW - CT imaging

KW - Mechanism of injury

KW - Radiation exposure

UR - http://www.scopus.com/inward/record.url?scp=84890035100&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84890035100&partnerID=8YFLogxK

U2 - 10.1097/TA.0b013e3182ab065b

DO - 10.1097/TA.0b013e3182ab065b

M3 - Article

C2 - 24256672

AN - SCOPUS:84890035100

VL - 75

SP - 995

EP - 1001

JO - Journal of Trauma and Acute Care Surgery

JF - Journal of Trauma and Acute Care Surgery

SN - 2163-0755

IS - 6

ER -