Chest x-ray as a screening tool for blunt thoracic trauma in children.
BACKGROUND
With the increasing use of thoracic computed tomography (CT) to screen for injuries in pediatric blunt thoracic trauma (BTT), we determined whether chest x-ray (CXR) and other clinical and epidemiologic variables could be used to predict significant thoracic injuries, to inform the selective use of CT in pediatric BTT. We further queried if these were discrepant from factors associated with the decision to obtain a thoracic CT.


METHODS
This retrospective cohort study included cases of BTT from three Level I pediatric trauma centers between April 1999 and March 2008. Pre-CT epidemiologic, clinical, and radiologic variables associated with CT findings of any thoracic injury or a significant thoracic injury as well as the decision to obtain a thoracic CT were determined using logistic regression.


RESULTS
Of 425 patients, 40% patients had a significant thoracic injury, 49% had nonsignificant thoracic injury, and 11% had no thoracic injury at all. Presence of hydrothorax and/or pneumothorax on CXR significantly increased the likelihood of significant chest injury visualized by CT (adjusted odds ratio 10.8; 95% confidence interval, 6.5-18), as did the presence of isolated subcutaneous emphysema (adjusted odds ratio, 19.8; 95% confidence interval, 2.3-168). Although a normal CXR finding was not statistically associated with a reduced risk of significant thoracic injury, 8 of the 9 cases with normal CXR findings and significant injuries involved occult pneumothoraces or hemothoraces not requiring intervention. Converse to features suggesting increased risk of significant injury, the decision to obtain a thoracic CT was only associated with later period in the study and obtaining a CT scan of another body region.


CONCLUSIONS
CXR can be used to screen for significant thoracic injuries and direct the selective use of thoracic CT in pediatric BTT. Prospective studies are needed to validate these findings and develop guidelines that include CXR to define indications for thoracic CT in pediatric BTT.


METHODS
Prognostic study, level III.
From the Division of Pediatric General Surgery and IWK Trauma Care Program (N.L.Y., K.W.), IWK Health Centre, Halifax, Nova Scotia; and Pediatric Trauma Program (M.B.), Children's Hospital of Eastern Ontario; and Pediatric Trauma Program (B.S.), Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada; and Department of Epidemiology and Preventive Medicine (C.S.P.), Monash University; and Trauma Service (C.S.P., J.C.), Royal Children's Hospital, Melbourne; and Division of Women's, Adolescent and Children's Services (M.Z.E.), Royal Hobart Hospital, Hobart, Tasmania, Australia.
Natalie L
NL
Yanchar
Kenneth
K
Woo
Maureen
M
Brennan
Cameron S
CS
Palmer
Michael
M
Zs Ee
Brian
B
Sweeney
Joe
J
Crameri
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D016015:Logistic Models; D008297:Male; D012189:Retrospective Studies; D013898:Thoracic Injuries / Q000000981:diagnostic imaging*; D014057:Tomography, X-Ray Computed; D014193:Trauma Centers; D014949:Wounds, Nonpenetrating / Q000000981:diagnostic imaging*