title: Chest computed tomography imaging for blunt pediatric trauma: not worth the radiation risk.
abstract: BACKGROUND
  A child's risk of developing cancer from radiation exposure associated with computed tomography (CT) imaging is estimated to be as high as 1/500. Chest CT (CCT), often as part of a "pan-scan," is increasingly performed after blunt trauma in children. We hypothesized that routine CCT for the initial evaluation of blunt injured children does not add clinically useful information beyond chest radiograph (CXR) and rarely changes management.
  
  
  METHODS
  Pediatric (<15 y) trauma team evaluations over 6 y at an academic Level I trauma center were reviewed. Demographic data, injuries, imaging, and management were identified for all patients undergoing CT. Effective radiation dose in milliSieverts (mSv) was calculated using age-adjusted scales.
  
  
  RESULTS
  Fifty-seven of 174 children (33%) undergoing CT imaging had a CCT; 55 (97%) of these had a CXR. Pathology was identified in significantly fewer CXRs compared with CCTs (51% versus 83%, P < 0.001). All 7/57 (12%) emergent or urgent chest interventions were based on information from CXR. In 53 children (93%), the CCT was ordered as part of a pan-scan, resulting in a radiation dose of 37.69 ± 7.80 mSv from initial CT scans. Radiation dose was significantly greater from CCT than from CXR (8.7 ± 1.1 mSv versus 0.017 ± 0.002 mSv, P < 0.001).
  
  
  CONCLUSIONS
  Clinically useful information found on CCT had good correlation to information obtained from CXR and did not change patient management, however, did add significantly to the radiation exposure of initial imaging. We recommend selective use of CCT, particularly in the presence of an abnormal mediastinal silhouette on CXR after a significant deceleration injury.
authors.affiliation: University of Colorado School of Medicine, Aurora, Colorado 80206, USA. courtenay.holscher@ucdenver.edu
authors.forename: Courtenay M
authors.initials: CM
authors.lastname: Holscher
authors.forename: Leonard W
authors.initials: LW
authors.lastname: Faulk
authors.forename: Ernest E
authors.initials: EE
authors.lastname: Moore
authors.forename: Clay
authors.initials: C
authors.lastname: Cothren Burlew
authors.forename: Hunter B
authors.initials: HB
authors.lastname: Moore
authors.forename: Camille L
authors.initials: CL
authors.lastname: Stewart
authors.forename: Fredric M
authors.initials: FM
authors.lastname: Pieracci
authors.forename: Carlton C
authors.initials: CC
authors.lastname: Barnett
authors.forename: Denis D
authors.initials: DD
authors.lastname: Bensard
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D015601:Injury Severity Score; D008297:Male; D009381:Neoplasms, Radiation-Induced / Q000453:epidemiology*; D011829:Radiation Dosage; D013902:Radiography, Thoracic / Q000009:adverse effects; D012189:Retrospective Studies; D012307:Risk Factors; D013898:Thoracic Injuries / Q000000981:diagnostic imaging* / Q000453:epidemiology*; D014057:Tomography, X-Ray Computed / Q000009:adverse effects*; D014193:Trauma Centers; D019564:Unnecessary Procedures; D014949:Wounds, Nonpenetrating / Q000000981:diagnostic imaging* / Q000453:epidemiology*
keywords: Blunt trauma; CT; Chest; Computed tomography; Pediatric; Radiation; Thoracic; Trauma