Should helical CT scanning of the thoracic cavity replace the conventional chest x-ray as a primary assessment tool in pediatric trauma? An efficacy and cost analysis

Pediatric traumatic pulmonary herniation: A case report

“…Smaller observational studies note that typical indications for CT imaging were thoracic injury on chest radiograph and high impact force, with few relying solely on physical examination findings. In one study, of 45 children identified at a level 1 trauma center who all had both plain radiographs and CT, 18 patients had findings on CT not seen on chest radiograph [8]. However, only six patients had a change in therapy based on CT results.…”

“…Power was lacking to determine the presence of non-radiologic predictive variables that may have otherwise identified the need for thoracic CT scan . One large observational study of 235 children presenting to a level 1 Trauma Center noted that of 145 reportedly "normal" chest radiographs, the chest CT scan was abnormal in 47.6% [8].…”

Fluid Resuscitation and Massive Transfusion Protocol in Pediatric Trauma

“…From all chest imaging methods, standard anteriorposterior chest X-ray is a cost-effective screening tool that will reveal most of the thoracic abnormalities (7). On the other hand, urinalysis or serum chemistries are of little use in pediatric trauma.…”

“…Exsanguination, either at the site of the accident, or in hospital, accounts for 45% of all traumatic deaths. Motor vehicle collisions (59% mortality from all accidents in age group [5][6][7][8][9][10][11][12][13][14], pedestrian and bicycle accidents, falls, burns, and physical assault are the most common causes of injury in children (1). Many of injured children will require surgical treatment with involvement of the anesthesiologist.…”

Routine CT- Chest in Primary Evaluation of the Major Blunt Trauma Patients; Pros and Cons

“…For example, the finding of an aortic or great vessel injury or spine fracture would mandate critical management or diagnostic manoeuvres, while the diagnosis of an occult pneumothorax may not (Brazel et al, 1999). Therefore, use of CCT in Selected patients can lead to significant changes in patient management (18-41%) (Trupka et al, 1997;Guerrero-Lopez et al, 2000;Renton, 2003;Salim et al, 2006;Deunk et al, 2007) while application of CCT more liberally results in little consequential intervention overall (Blostein and Hodgeman, 1997;Plurad et al, 2007;Wisbach et al, 2007) based on these occult diagnoses. On the other hand, others argue that the highe r d i s c o v e r y o f i n j u r i e s w i t h C T i s o f questionable clinical significance at great costs.…”