Nuking the radiation: minimizing radiation exposure in the evaluation of pediatric blunt trauma.
OBJECTIVE
Our objective is to highlight recent literature investigating low-radiation diagnostic strategies in the evaluation of pediatric trauma.


RESULTS
In the area of minor head injury, research has focused on implementation of validated clinical decision rules into practice to reduce unnecessary computed tomography scans. Clinical observation may also serve as an adjunct to initial assessment and a potential substitute for computed tomography imaging. Subgroups of children with special needs or severe injury mechanisms may also be safely characterized by the clinical decision rule and spared radiation exposure. Physical examination techniques may be useful in diagnosing mandibular fractures. In addition, evidence suggests that plain radiography for evaluation of blunt thoracic trauma may be sufficient in many cases, and computed tomography could be reserved for those with abnormal radiographs, high-risk mechanisms, or abnormal physical findings. Clinical decision rules are able to predict intra-abdominal injury with high sensitivity. Data suggest that skeletal surveys may be modified to limit radiation exposure in the case of suspected nonaccidental trauma.


CONCLUSIONS
More research is needed in development of pediatric-specific clinical decision rules and risk stratification and in testing low-radiation diagnostic modalities in the pediatric trauma population.
Department of Pediatrics, Columbia University College of Physicians and Surgeons, New York, New York, USA.
Joan S
JS
Bregstein
Tamar R
TR
Lubell
Alice M
AM
Ruscica
Cindy G
CG
Roskind
D000007:Abdominal Injuries / Q000000981:diagnostic imaging*; D002648:Child; D002675:Child, Preschool; D006259:Craniocerebral Trauma / Q000000981:diagnostic imaging*; D003657:Decision Making; D005260:Female; D006801:Humans; D015601:Injury Severity Score; D008297:Male; D010372:Pediatrics / Q000379:methods / Q000639:trends*; D010808:Physical Examination; D019095:Point-of-Care Systems; D011832:Radiation Injuries / Q000209:etiology / Q000517:prevention & control*; D018570:Risk Assessment; D013898:Thoracic Injuries / Q000000981:diagnostic imaging*; D014057:Tomography, X-Ray Computed / Q000009:adverse effects / Q000706:statistics & numerical data; D019564:Unnecessary Procedures; D014949:Wounds, Nonpenetrating / Q000000981:diagnostic imaging*