Chest injuries represent the second most common cause of pediatric trauma related death. ATLS guidelines recommend CXR in all blunt trauma patients. Previous studies have suggested a low risk of occult intrathoracic trauma; however, these studies included many children who were sent home.
Predictors of thoracic injury include: abdominal signs or symptoms (OR 7.7), thoracic signs of symptoms (OR 6), abnormal chest auscultation (OR 3.5), oxygen saturation < 95% (OR 3.1), BP < 5% for age (OR 3.7), and femur fracture (OR 2.5).
4.3 % of those found to have thoracic injuries did not have any of the above predictors, but their injuries were diagnosed on CXR. These children did not require trauma related interventions.
Bottom line: There were still a number of children without these predictors that had thoracic injuries, so the authors suggest that chest xray should remain a part of pediatric trauma resuscitation.
Answer
This was a retrospective review of children aged 0-17 with blunt trauma requiring trauma team activation who had a chest xray preformed. 483 eligible children were included, all of whom were admitted to the hospital. 108 children had their thoracic injury detected on chest xray, 110 on chest CT and 76 on abdominal CT. Pneumothorax, pulmonary contusion and multiple rib fractures were the most commonly found thoracic injuries. All children also had other injuries.
References
Weerdenburg et al. Predicting Thoracic Injury in Children with Multi-trauma. Pediatric Emergency Care. Epub ahead of print. 2017.
