Utility of Reflexive Chest Radiograph in Pediatric Trauma.
Erika Lindholm, MD1; Darshan Parikh, BA2; Hannan Khan, BA2; Teerin Meckmongkol, MD1; Rajeev Prasad, MD1; L. Grier Arthur, MD1; Harsh Grewal, MD1; Jacqueline Urbine, MD1; Sean Ciullo, MD1
1St. Christopher's Hospital for Children, Philadelphia, PA; 2Drexel University, Philadelphia, PA
Background: Advanced trauma life support guidelines recommend that all trauma victims undergo routine chest radiograph (CR) following primary survey. We reviewed our clinical experience to determine if routine CR in pediatric trauma is useful.
Methods: A retrospective review was conducted for trauma activations between 2015 and 2017 at a Level 1 pediatric trauma center. Demographics, level of activation (L1, L2, L3), and imaging studies were reviewed. A significant CR was defined as any abnormal interpretation.
Results: A total of 1374 patients were identified. Majority of patients (59.3%) underwent CR. Patients with CR included 83.6% L1s, 87.4% L2 and 48.2% L3. L1 patients without CR (12) included 7 dead on arrival, 1 emergency thoracotomy and 3 isolated burn injuries. Significant CR was identified in 5.9% of patients. L1 was most likely to have significant findings (30.0%), followed by L2 (9.2%) and L3 (3.0%). CR findings were atelectasis/contusion (44.7%), fracture (40%), bullet fragments (8.2%), effusion (2.3%), pneumothorax (2.3%) and subcutaneous emphysema (2.3%).
Conclusions: There are a large number of unnecessary CR performed on pediatric trauma patients. L1 patients are the likely to benefit from CR and reflexive imaging is supported by this data. However, due to the low frequency of abnormal findings in L2 and L3 patients, routine CR should not be an absolute in there management.
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