Utility of complete trauma series radiographs in alert pediatric patients presenting to Emergency Department of a Tertiary Care Hospital

  • T. Alam Khan
  • Y. Jamil Khattak
  • M. AwaisEmail author
  • A. Alam Khan
  • Y. Husen
  • N. Nadeem
  • A. Rehman
Original Article



To assess the utility of trauma series radiographs in the management of alert pediatric patients with traumatic injury and to ascertain whether it is necessary to acquire the entire trauma series in these children.


A total of 176 consecutive children below the age of 15 years and having Glasgow Coma Scale score greater than 12, who presented to the emergency department of a tertiary care hospital with a history of recent trauma, were retrospectively reviewed. All the children had undergone a thorough clinical examination followed by complete trauma series radiographs, according to the American College of Surgery guidelines.


A total of 558 radiographs were reviewed by a consultant pediatric radiologist including 528 trauma series radiographs and 30 additional radiographs. Among the trauma series radiographs, 35 (6.63 %) had evidence of injury; 24 (4.54 %) and 11 (2.08 %) involving the chest and pelvic regions, respectively. All children with normal physical examination had normal cervical spine and chest radiographs. Among the 11 positive pelvic X-rays, only two had radiological signs of injury in the absence of localizing physical signs, and all these children were less than 3 years of age. In all the remaining cases, children had localizing signs on physical examination. Out of the 30 additional X-rays, 27 (90 %) had radiological evidence of injury.


The routine use of entire radiological trauma series in alert pediatric patients with a normal physical examination has a very low yield. In these children, the localizing signs and symptoms can help us in determining the specific radiological examination to be utilized.


Wounds and injuries Thoracic radiography Spinal injuries Thoracic injuries Physical examination Child 


Conflict of interest

Dr TA Khan has no conflict of interest to disclose. Dr YJ Khattak has nothing to disclose. Dr M Awais has no conflict of interest relevant to this article to disclose. Dr AA Khan has no conflict of interest to disclose. Dr Y Husen has nothing to disclose. Dr N Nadeem has no conflict of interest to disclose. Dr A Rehman has no conflict of interest relevant to this article to disclose.

Ethical standards

The study was approved by the Ethics Review Committee of the institution and was performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki.


  1. 1.
    National Centre for Injury Prevention and Control. Accessed 12 Mar 2013.
  2. 2.
    Kool DR, Blickman JG. Advanced Trauma Life Support. ABCDE from a radiological point of view. Emerg Radiol. 2007;14:135–41.PubMedCentralPubMedCrossRefGoogle Scholar
  3. 3.
    Kim PK, Zhu X, Houseknecht E, Nickolaus D, Mahboubi S, Nance ML. Effective radiation dose from radiologic studies in pediatric trauma patients. World J Surg. 2005;29:1557–62.PubMedCrossRefGoogle Scholar
  4. 4.
    Rybicki F, Nawfel RD, Judy PF, Ledbetter S, Dyson RL, Halt PS, et al. Skin and thyroid dosimetry in cervical spine screening: two methods for evaluation and a comparison between a helical CT and radiographic trauma series. Am J Roentgenol. 2002;179:933–7.CrossRefGoogle Scholar
  5. 5.
    Gillott A, Rhodes M, Lucke J. Utility of routine pelvic X-ray during blunt trauma resuscitation. J Trauma. 1988;28:1570–4.PubMedCrossRefGoogle Scholar
  6. 6.
    Kevill K, Wong AM, Goldman HS, Gershel JC. Is a complete trauma series indicated for all pediatric trauma victims? Pediatr Emerg Care. 2002;18:75–7.PubMedCrossRefGoogle Scholar
  7. 7.
    Ciorciari AJ, Cooper A. Multiple trauma. In: Crain EF, Gershel JC, editors. Clinical manual of emergency pediatrics. 3rd ed. New York: McGraw-Hill; 1997. p. 628–38.Google Scholar
  8. 8.
    Cantor RM, Leaming JM. Evaluation and management of pediatric major trauma. Emerg Med Clin N Am. 1998;16:229–56.CrossRefGoogle Scholar
  9. 9.
    Ramrattan NN, Oner FC, Boszczyk BM, Castelein RM, Heini PF. Cervical spine injury in the young child. Eur Spine J. 2012;21:2205–11.PubMedCentralPubMedCrossRefGoogle Scholar
  10. 10.
    Hoffman JR, Schriger DL, Mower W, Luo JS, Zucker M. Low-risk criteria for cervical-spine radiography in blunt trauma: a prospective study. Ann Emerg Med. 1992;21:1454–60.PubMedCrossRefGoogle Scholar
  11. 11.
    Hoffman JR, Wolfson AB, Todd K, Mower WR. Selective cervical spine radiography in blunt trauma: methodology of the National Emergency X-Radiography Utilization Study (NEXUS). Ann Emerg Med. 1998;32:461–9.PubMedCrossRefGoogle Scholar
  12. 12.
    Egloff AM, Kadom N, Vezina G, Bulas D. Pediatric cervical spine trauma imaging: a practical approach. Pediatr Radiol. 2009;39:447–56.PubMedCrossRefGoogle Scholar
  13. 13.
    Viccellio P, Simon H, Pressman BD, Shah MN, Mower WR, Hoffman JR, NEXUS Group. A prospective multicenter study of cervical spine injury in children. Pediatrics. 2001;108:E20.PubMedCrossRefGoogle Scholar
  14. 14.
    Peterson RJ, Tepas JJ 3rd, Edwards FH, Kissoon N, Pieper P, Ceithaml EL. Pediatric and adult thoracic trauma: age-related impact on presentation and outcome. Ann Thorac Surg. 1994;58:14–8.PubMedCrossRefGoogle Scholar
  15. 15.
    Balci AE, Kazez A, Eren S, Ayan E, Ozalp K, Eren MN. Blunt thoracic trauma in children: review of 137 cases. Eur J Cardiothorac Surg. 2004;26:387–92.PubMedCrossRefGoogle Scholar
  16. 16.
    Bliss D, Silen M. Pediatric thoracic trauma. Crit Care Med 2002;30:S409–15.Google Scholar
  17. 17.
    Färber D, Hahn H, Fendt-Klug T, Höpner F. Thoracic trauma in childhood. Radiologic findings. Radiologe. 1995;35:385–90.PubMedGoogle Scholar
  18. 18.
    Soundappan S, Smith NF, Lam LT, Holland AJ, McCaskill M, Cass DT. A trauma series in the injured child: do we really need it? Pediatr Emerg Care. 2006;22:710–6.PubMedCrossRefGoogle Scholar
  19. 19.
    Wisbach GG, Sise MJ, Sack DI, Swanson SM, Sundquist SM, Paci GM, et al. What is the role of chest X-ray in the initial assessment of stable trauma patients? J Trauma. 2007;62:74–8.PubMedCrossRefGoogle Scholar
  20. 20.
    Rees MJ, Aickin R, Lolbe A, Teele RL. The screening pelvic radiograph in pediatric trauma. Pediatr Radiol. 2001;31:497–500.PubMedCrossRefGoogle Scholar
  21. 21.
    Ramirez DW, Schuette JJ, Knight V, Johnson E, Denise J, Walker AR. Necessity of routine pelvic radiograph in the pediatric blunt trauma patient. Clin Pediatr. 2008;47:935–40.CrossRefGoogle Scholar
  22. 22.
    Löw R, Düber C, Schweden F, Lehmann L, Blum J, Thelen M. Whole body spiral CT in primary diagnosis of patients with multiple trauma in emergency situations. Rofo. 1997;166(5):382–8.PubMedCrossRefGoogle Scholar
  23. 23.
    Strohm PC, Uhl M, Hauschild O, Stankovic Z, Reising KJ, Lesniak M, Südkamp NP. What is the value of the whole body spiral CT in the primary radiological imaging of severely injured children? Z Orthop Unfall. 2008;146(1):38–43.PubMedGoogle Scholar
  24. 24.
    Maurer MH, Knopke S, Schröder RJ. Added diagnostic benefit of 16-row whole-body spiral CT in patients with multiple trauma differentiated by region and injury severity according to the ATLS concept. Rofo. 2008;180(12):1117–23.PubMedCrossRefGoogle Scholar
  25. 25.
    Moore HB, Faulk LW, Moore EE, Pierraci F, Cothren Burlew C, Holscher CM, Barnett CC, Jurkovich GJ, Bensard DD. Mechanism of injury alone is not justified as the sole indication for computed tomographic imaging in blunt pediatric trauma. J Trauma Acute Care Surg. 2013;75(6):995–1001.PubMedCrossRefGoogle Scholar
  26. 26.
    Scaife ER, Rollins MD. Managing radiation risk in the evaluation of the pediatric trauma patient. Semin Pediatr Surg. 2010;19(4):252–6.PubMedCrossRefGoogle Scholar
  27. 27.
    Segal LS, Shrader MW. Missed fractures in pediatric trauma patients. Acta Orthop Belg. 2013;79(6):608–15.PubMedGoogle Scholar
  28. 28.
    Gravel J, Gouin S, Carrière B, Gaucher N, Bailey B. Unfavourable outcome for children leaving the emergency department without being seen by a physician. CJEM. 2013;15(5):289–99.PubMedGoogle Scholar
  29. 29.
    Hui CM, MacGregor JH, Tien HC, Kortbeek JB. Radiation dose from initial trauma assessment and resuscitation: review of the literature. Can J Surg. 2009;52(2):147–52.PubMedCentralPubMedGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2014

Authors and Affiliations

  • T. Alam Khan
    • 1
  • Y. Jamil Khattak
    • 1
  • M. Awais
    • 1
    Email author
  • A. Alam Khan
    • 2
  • Y. Husen
    • 3
  • N. Nadeem
    • 3
  • A. Rehman
    • 2
  1. 1.Department of RadiologyAga Khan University HospitalKarachiPakistan
  2. 2.Department of Biological & Biomedical SciencesAga Khan UniversityKarachiPakistan
  3. 3.Section of Pediatrics, Department of RadiologyAga Khan University HospitalKarachiPakistan

Personalised recommendations