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Chest CT Scan in the Evaluation of Pediatric Thoracic Trauma
Jamie Golden, MD, Jessica Zagory, MD, Catherine Goodhue, MN, Rita Burke, PhD, MPH, Jeffrey Upperman, MD, and Christopher Gayer, MD, PhD, Children's Hospital of Los Angeles, Los Angeles CA

Abstract:
Purpose:
To evaluate the utility of chest X-ray (CXR) and chest CT (CCT) in the identification of thoracic injuries in pediatric blunt trauma patients. We hypothesized that chest CT is overused in the pediatric population. Methods: All blunt trauma activations that underwent a CT scan of the chest at a pediatric trauma center from 2005-2013 were retrospectively reviewed. Results: CCT and CXR were performed in 114 patients and 96% were part of a "pan-scan." One hundred six patients did not require a chest tube or thoracotomy after CCT. CXR findings in this group included: contusion or atelectasis (32), widened mediastinum (8), 1st rib fracture (3), pneumothorax or hemothorax (5), pneumomediastinum (2), and no injury (59). A chest tube was placed in seven patients. CXR findings in this group included: widened mediastinum (1), 1st rib fracture (2), and pneumothorax (4). One patient with a widened mediastinum and hemothorax on CXR had an aortic dissection diagnosed on CCT and required a thoracotomy. CCT did not change management in blunt trauma patients with a normal mediastinum on CXR. CCT used only for patients with an abnormal mediastinum on CXR would result in 89% fewer scans. Conclusion: The use of CCT should be limited to the identification of vascular injuries in the setting of an abnormal mediastinum on CXR. CCT as part of a "pan-scan" leads to unnecessary radiation in the at-risk pediatric population.
Objective:
At the end of this activity, the learner will be able to identify patients who will benefit from a CT Scan of the chest after blunt trauma.
Objective Content: The use of CT scan of the chest should be limited to patients with an abnormal mediastinum on chest Xray to identify vascular injuries.


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