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 language | English (US) |
|---|---|
| Pages (from-to) | 995-1001 |
| Number of pages | 7 |
| Journal | Journal of Trauma and Acute Care Surgery |
| Volume | 75 |
| Issue number | 6 |
| DOIs | |
| State | Published - Dec 1 2013 |
| Externally published | Yes |
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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 journal › Article
}
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 -