Isolated computed tomography diagnosis of pulmonary contusion does not correlate with increased morbidity

Kwon, Ae‐Ran; Sorrells, Donald L.; Kurkchubasche, Arlet G.; Cassese, John A.; Tracy, Thomas F.; Luks, François I.

doi:10.1016/j.jpedsurg.2005.10.009

Cited by 35 publications

(12 citation statements)

References 17 publications

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“…(29) Although chest CT is more accurate in diagnosing rib fractures(30) and pulmonary contusions,(31) these findings don't translate into clinical interventions not otherwise made based on radiographs and clinical monitoring. (31,32) Second, ISS in the adult trauma population is generally much higher than in most pediatric populations, including ours; therefore, increased CT evaluation may be warranted to assess for these more severe injuries. (23,33) Third, as part of the list of “Five things physicians and patients should question” for the Choosing Wisely campaign, the American College of Surgery recommends against the routine performance of whole-body CT in patients with minor or single system trauma.…”

Section: Discussionmentioning

confidence: 90%

Variation in Computed Tomography Imaging for Pediatric Injury-Related Emergency Visits

Marin

Wang

Winger

et al. 2015

The Journal of Pediatrics

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Objectives To assess variation in the use of computed tomography (CT) for pediatric injury-related emergency department (ED) visits. Study design Retrospective cohort study of visits to 14 network-affiliated EDs from November 2010 through February 2013. Visits were identified by International Classification of Diseases, 9th revision, Clinical Modification diagnosis codes. Primary outcome was CT use. We used descriptive statistics and performed multivariable logistic regression to evaluate the association of patient and ED covariates on any and body region-specific CT use. Results Of the 80,868 injury-related visits, 11.4% included CT, and 28.4% of those had more than one study. Across EDs, CT use ranged from 7.6%- 25.5% of visits and did not correlate with institutional injury severity score (P=0.33) or admission/transfer rates (P=0.07). In multivariable analysis of non-pediatric EDs, trauma centers and non-academic EDs were associated with CT use. Higher pediatric volume was associated with any CT use, however, there was an inverse relationship between volume and non-head CT use. When the pediatric ED was included in multivariable modeling, the effect of level 1-3 trauma center designation remained, and the pediatric level 1 trauma center was less likely to use most body region-specific CTs. Conclusions There is wide variation in CT imaging for pediatric injury-related visits not solely attributable to case mix. Future work to optimize CT utilization should focus on additional factors contributing to imaging practices and interventions.

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Section: Discussionmentioning

confidence: 90%

Variation in Computed Tomography Imaging for Pediatric Injury-Related Emergency Visits

Marin

Wang

Winger

et al. 2015

The Journal of Pediatrics

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“…CT may actually be too sensitive in identifying clinically nonsignificant injuries. 8 This is an area of controversy not addressed in this Practice Management Guidelines. Because many victims of blunt trauma do undergo a chest and/or abdominal computed tomographic scan evaluation, hemothorax not seen on initial chest radiographs might be identified and treated.…”

Section: Computed Tomographymentioning

confidence: 99%

Practice Management Guidelines for Management of Hemothorax and Occult Pneumothorax

Mowery

Gunter

Collier

et al. 2011

Journal of Trauma: Injury, Infection &Amp; Critical Care

177

143

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“…Computed tomography (CT) has a higher sensitivity than radiographs for detecting lung parenchymal changes [6,7]. Nevertheless, the visual confirmation of bilateral pulmonary infiltrates by CT instead of chest X-rays is not supported by the current ALI definition and carries the risk of detecting pulmonary opacifications with limited clinical relevance [1,6].…”

Section: Introductionmentioning

confidence: 99%

Computed tomographic assessment of lung weights in trauma patients with early posttraumatic lung dysfunction

Reske

Heine

et al. 2011

Critical Care

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IntroductionQuantitative computed tomography (qCT)-based assessment of total lung weight (Mlung) has the potential to differentiate atelectasis from consolidation and could thus provide valuable information for managing trauma patients fulfilling commonly used criteria for acute lung injury (ALI). We hypothesized that qCT would identify atelectasis as a frequent mimic of early posttraumatic ALI.MethodsIn this prospective observational study, Mlung was calculated by qCT in 78 mechanically ventilated trauma patients fulfilling the ALI criteria at admission. A reference interval for Mlung was derived from 74 trauma patients with morphologically and functionally normal lungs (reference). Results are given as medians with interquartile ranges.ResultsThe ratio of arterial partial pressure of oxygen to the fraction of inspired oxygen was 560 (506 to 616) mmHg in reference patients and 169 (95 to 240) mmHg in ALI patients. The median reference Mlung value was 885 (771 to 973) g, and the reference interval for Mlung was 584 to 1164 g, which matched that of previous reports. Despite the significantly greater median Mlung value (1088 (862 to 1,342) g) in the ALI group, 46 (59%) ALI patients had Mlung values within the reference interval and thus most likely had atelectasis. In only 17 patients (22%), Mlung was increased to the range previously reported for ALI patients and compatible with lung consolidation. Statistically significant differences between atelectasis and consolidation patients were found for age, Lung Injury Score, Glasgow Coma Scale score, total lung volume, mass of the nonaerated lung compartment, ventilator-free days and intensive care unit-free days.ConclusionsAtelectasis is a frequent cause of early posttraumatic lung dysfunction. Differentiation between atelectasis and consolidation from other causes of lung damage by using qCT may help to identify patients who could benefit from management strategies such as damage control surgery and lung-protective mechanical ventilation that focus on the prevention of pulmonary complications.

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Isolated computed tomography diagnosis of pulmonary contusion does not correlate with increased morbidity

Cited by 35 publications

References 17 publications

Variation in Computed Tomography Imaging for Pediatric Injury-Related Emergency Visits

Variation in Computed Tomography Imaging for Pediatric Injury-Related Emergency Visits

Practice Management Guidelines for Management of Hemothorax and Occult Pneumothorax

Computed tomographic assessment of lung weights in trauma patients with early posttraumatic lung dysfunction

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