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Diagnostic Yield of CT Imaging for Pediatric Axial Skeletal Injuries
Avionna Baldwin, BS1; Clauden Louis, MD1; Jamal Jefferson, BA1; Derek Wakeman, MD2; Addisu Mesfin, MD1
1University of Rochester School of Medicine and Dentistry, Rochester, NY; 2University of Rochester School of Medicine, Rochester, NY

Background: We aimed to evaluate the diagnostic yield of computed tomography (CT) scans of the axial skeleton in traumatically-injured pediatric patients. CT imaging has become ubiquitous in the assessment of axial skeletal injuries in trauma patients. As pressure mounts to promptly diagnose emergent conditions, children are at risk of high cumulative radiation exposure and its sequelae. We hypothesized that CT scanning was over-utilized at our institution.

Methods: Medical records of pediatric trauma patients 18 years old and younger who underwent axial skeletal CT imaging at a tertiary care facility from 2013 to 2015 were retrospectively reviewed.

Results: Of patients with axial skeletal fractures, 26% were detected on plain films (See table). The remaining fractures were not seen (52%) or did not have plain films (20%). 10 injuries were clinically significant requiring surgery or stabilization (1 cervical, 2 thoracic, 3 lumbar, and 4 pelvic); 3 of these were seen on plain films. Of the 5 patients with radiographic cervical spine injury none were detected on plain films (3 did not have plain films) and none required stabilization.

Conclusion: Given the low incidence of cervical spine injuries found in pediatric patients that underwent CT imaging, guidelines are needed to reduce unnecessary scans. A lower threshold may be warranted to obtain CT imaging for the remainder of the axial skeleton given the low detection rate by plain films.

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