title: Clinical predictors for the selective use of chest radiographs in pediatric blunt trauma evaluations.
abstract: BACKGROUND
  Chest radiographs continue to be a routine part of the evaluation of children sustaining blunt trauma. This study sought to determine those clinical markers associated with an abnormal chest radiograph in nonintubated, pediatric, blunt trauma victims.
  
  
  METHODS
  A retrospective case-control study was performed for severely injured pediatric trauma patients presenting to our emergency department between January 1, 1996, and December 31, 1997. Abnormal chest radiographs were identified through the trauma registry and four controls were matched to each case. Radiographs were reevaluated by our study radiologist. Variables associated with an abnormal chest radiograph were grouped to develop a set of clinical markers that could predict an abnormal chest radiograph with a high degree of sensitivity.
  
  
  RESULTS
  An initial chest radiograph was obtained in 457 of 587 trauma patients. Thirty study patients with an abnormal radiograph that met inclusion criteria were analyzed with 133 controls. The presence of either an abnormal respiratory rate for age, chest tenderness, or back abrasions had a sensitivity of 1.0 (95% confidence interval, 0.86-1.0) and a specificity of 0.38 (95% confidence interval, 0.30-0.47).
  
  
  CONCLUSIONS
  In pediatric trauma patients, the presence of chest tenderness, back abrasions, or an abnormal respiratory rate identified all abnormal chest radiographs.
authors.affiliation: Division of Emergency Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio 45229, USA. gittm1@cchmc.org
authors.forename: Michael A
authors.initials: MA
authors.lastname: Gittelman
authors.forename: Javier
authors.initials: J
authors.lastname: Gonzalez-del-Rey
authors.forename: Alan S
authors.initials: AS
authors.lastname: Brody
authors.forename: Gregg A
authors.initials: GA
authors.lastname: DiGiulio
mesh_terms: D016022:Case-Control Studies; D016009:Chi-Square Distribution; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D016015:Logistic Models; D008297:Male; D011237:Predictive Value of Tests; D013902:Radiography, Thoracic / Q000379:methods*; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D018709:Statistics, Nonparametric; D013898:Thoracic Injuries / Q000000981:diagnostic imaging*; D014949:Wounds, Nonpenetrating / Q000000981:diagnostic imaging*