Skip to main content

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

Abstract

Purpose

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.

Methods

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.

Results

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.

Conclusions

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.

This is a preview of subscription content, access via your institution.

Fig. 1
Fig. 2

References

  1. 1.

    National Centre for Injury Prevention and Control. http://www.cdc.gov/injury/wisqars/index.html. 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.

    PubMed Central  PubMed  Article  Google 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.

    PubMed  Article  Google 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.

    Article  Google 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.

    CAS  PubMed  Article  Google 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.

    PubMed  Article  Google 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.

    CAS  Article  Google 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.

    PubMed Central  PubMed  Article  Google 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.

    CAS  PubMed  Article  Google 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.

    CAS  PubMed  Article  Google 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.

    PubMed  Article  Google 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.

    CAS  PubMed  Article  Google 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.

    CAS  PubMed  Article  Google 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.

    PubMed  Article  Google Scholar 

  16. 16.

    Bliss D, Silen M. Pediatric thoracic trauma. Crit Care Med 2002;30:S409–15.

  17. 17.

    Färber D, Hahn H, Fendt-Klug T, Höpner F. Thoracic trauma in childhood. Radiologic findings. Radiologe. 1995;35:385–90.

    PubMed  Google 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.

    PubMed  Article  Google 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.

    PubMed  Article  Google Scholar 

  20. 20.

    Rees MJ, Aickin R, Lolbe A, Teele RL. The screening pelvic radiograph in pediatric trauma. Pediatr Radiol. 2001;31:497–500.

    CAS  PubMed  Article  Google 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.

    Article  Google 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.

    PubMed  Article  Google 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.

    CAS  PubMed  Google 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.

    CAS  PubMed  Article  Google 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.

    PubMed  Article  Google 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.

    PubMed  Article  Google Scholar 

  27. 27.

    Segal LS, Shrader MW. Missed fractures in pediatric trauma patients. Acta Orthop Belg. 2013;79(6):608–15.

    PubMed  Google 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.

    PubMed  Google 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.

    PubMed Central  PubMed  Google Scholar 

Download references

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.

Author information

Affiliations

Authors

Corresponding author

Correspondence to M. Awais.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Alam Khan, T., Jamil Khattak, Y., Awais, M. et al. Utility of complete trauma series radiographs in alert pediatric patients presenting to Emergency Department of a Tertiary Care Hospital. Eur J Trauma Emerg Surg 41, 279–285 (2015). https://doi.org/10.1007/s00068-014-0413-8

Download citation

Keywords

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