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Utility of Thoracic CT Scan: A Decision Rule for Acquisition During Initial Pediatric Trauma Evaluation
Caroline Q. Stephens, BA1, Meredith C. Boulos, BS1, Christopher R. Connelly, MD1, Mubeen Jafri, MD1,2, Arvin Gee, MD, PhD2, Sanjay Krishnaswami, MD1,2. 1Oregon Health and Science University, Portland, OR, USA, 2Legacy Emanuel Medical Center-Randall Children's Hospital, Portland, OR, USA.

Background: Thoracic Computed-Tomography (TCT) guidelines for initial trauma assessment are limited, despite widespread use of other body-region CT protocols. We hypothesized mechanism or Chest X-Ray (CXR) could predict significant injury independent of TCT, and TCT utilization would not decrease over time relative to other CTs.

Methods: Retrospective review of patients <18y.o. with TCT (20072015) treated at a level I trauma center. Baseline characteristics were examined and incidences of body region-specific CT were compared over time. Mechanism of injury, intrathoracic pathology, and interventions were compared in patients who received both TCT and CXR. Pearson Chi-Squared test with significance defined as p<0.05 was used for analysis.

Results: Characteristics were similar in all 3609 patients, 423 of whom received TCTs. Both TCT and CXR were obtained in 258 patients (median ISS=19.0), with TCT altering management in 6 (Table 1). This latter group was predicted by one of two mechanisms or CXR findings prompting CT; 4 underwent tube thoracostomy and 2 underwent operation (penetrating mechanism). While incidence of CT-Cervical-Spine (p<0.001), CT-Head (p<0.001), CT-Abdomen (p<0.001), and CT-Pelvis (p<0.01) decreased significantly, TCT incidence did not (p=0.12).

Conclusions: TCT use did not decrease over time and all interventions were predicted by CXR or injury mechanism. We propose a decision rule for prospective validation reserving TCT for patients with abnormal CXR findings, or for those with high-speed vehicle-related, or penetrating injuries.

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