Chest CT Scans In Adolescent Blunt Trauma Patients: Are They Being Overutilized?
Lilly Groszman1, Laurel Xiang2, Laurel Parker3, *Deepi Koganti4, *Alexis Smith4, *Randi Smith4, *Richard Sola, Jr.5
1McGill University, Montreal, QC, Canada2New York University, New York City, NY;3Augusta University, Augusta, GA;4Emory University, Atlanta, GA;5Morehouse School of Medicine, Atlanta, GA
Blunt trauma remains one of the leading causes of mortality in the pediatric population, accounting for approximately 90% of all pediatric trauma. The utility of chest computed tomography (CCT) is not well established in the diagnostic algorithm of adolescent blunt trauma patients. Our study’s aim was to audit CCT usage in the initial evaluation of adolescent blunt trauma.
We retrospectively reviewed adolescent blunt trauma patients aged [13-18] treated at our urban level 1 adult trauma center from 2014-2019. Our primary outcome was the rate of positive CCT findings that required intervention (chest tube placement, chest surgery, thoracentesis). Univariate and multivariate logistic regression was performed.
Findings:387 patients were reviewed. 308 patients were included in the analysis. A positive CCT consisted of pulmonary contusion (n=126), pneumothorax (n=82), bone defect (n=61) and hemothorax (n=16), and other (n=40). 83 patients had a positive chest X-ray (CXR) and 56 patients had both a positive CCT and CXR. GCS < 15, ISS and abnormal chest exam were significant for positive CCT and need for chest-related intervention. Of the patients who required a chest-related intervention (n=121), no intervention was determined based on CCT alone. All interventions were due to CXR and clinical findings (n=48) or CXR findings and clinical findings that were confirmed with a positive CCT (n=53). GCS < 15, ISS and abnormal chest exam and positive CXR were included in the multivariate analysis. The logistic regression model had an AUC score of 0.94 for requiring a chest-related intervention.
Conclusions (implications for practice):While CCT may provide valuable information, clinical exam coupled with low ionizing radiographic imaging (i.e. CXR) may sufficiently identify chest trauma after blunt mechanisms. This shift in management has the potential to reduce risk of radiation without compromising care of adolescent trauma patients at adult trauma centers.
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