S. Azari2, T. Hoover1, M. Browne1,2 1Lehigh Valley Health Network,Pediatric Surgical Specialties,Allentown, PA, USA 2University Of South Florida College Of Medicine,Tampa, FL, USA
Introduction: National attention has been drawn to decreasing pediatric radiation exposure with a push to “image gently”, however there are currently no national pediatric CT guidelines. CT scans aid in the evaluation and treatment of pediatric patients; unfortunately, they expose the child to a considerable amount of radiation. This creates a challenge for physicians, especially those caring for the acute pediatric trauma patient. Due to the flexibility of the pediatric chest wall, the incidence of thoracic injury with blunt trauma is low. We hypothesize that chest CT scans after a normal chest xray will not add clinically relevant information to justify the risk of the radiation.
Methods: A retrospective chart review of all level 1 trauma patients < 15 years of age who were evaluated at our pediatric trauma center between January 2013 and June 2016 was performed. Using our database and chart review, patients who had a chest CT scan during their initial evaluation were reviewed for demographics, mechanism of injury, radiological results, and change in management based on those results. Patients were excluded if their radiological evaluations were performed at an outside facility; no radiological chest evaluation was preformed; or if their mechanism of injury was drowning.
Results: There were 257 patients who met our inclusion criteria. Eighty-two percent (211/257) had a chest xray. Though 44% (114/257) had a chest CT scan; only 60% (68/114) of those patients had a chest xray prior to CT. Of those patients, 74% (50/68) had a normal x-ray. Thirty percent (15/50) of the chest CTs done after a normal x-ray had an abnormal result. Only 1 patient (2%) had a result which changed clinical management.
Conclusion: Though chest CT scans increase abnormal diagnoses, the chance of their results changing clinical management is very low. Chest CTs should be consider unnecessary when the chest xray is normal.