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Emergency whole-body CT scans in pediatric patients with trauma: patterns of injuries, yield of dual-phase scanning, and influence of second read on detection of injuries



To describe injury patterns in children with multiple trauma (MT), evaluate the yield of dual-phase whole-body CT (WBCT), and quantify missed injuries detected on second reading.


Remotely analyzed WBCT performed between 2011 and 2020 in 63 emergency departments on children admitted for MT were included. Second reading occurred within 24 h. Collected data included age, sex, mechanism, Injury Severity Score (ISS), radiologists’ experience, time and duration of first reading, conclusion of both readings, and dosimetry. Melvin score assessed the clinical impact of missed injuries.


Overall, 1114 patients were included, 1982 injuries were described in 662 patients (59.4%), 452/1114 (40.6%) WBCT were negative, and 314 (28.2%) patients had MT (≥ 2 body parts injured). The most frequent injuries were pulmonary contusions (8.3%), costal fractures (6.2%), and Magerl A1 vertebral fractures (4.9%). Overall, 151 injuries were missed in 92 (8.3%) patients. Independent predictors for missed injuries were age ≤ 4 years (p = 0.03), number of injured body parts ≥ 2 (p = 0.01), and number of injuries ≥ 3 (p < 0.001). Melvin score grade 3 lesions were found in 16/92 (17.4%) patients with missed injuries (1.4% of all WBCT), where only prolonged follow-up was necessary. Thirteen active bleeding or pseudoaneurysms were detected (0.7% of injuries).


Injuries were diagnosed in 59.4% of patients. Double-reading depicted additional injuries in 8.3% of patients, significantly more in children ≤ 4 years, with ≥ 3 injuries or ≥ 2 injured body parts. As 28 % of patients had MT and 1.1% had active extravasation or pseudoaneurysm, indication for WBCT should be carefully weighted.

Key Points

• When performed as a first-line imaging evaluation, approximately 41% of WBCT for MT children were considered normal.

• The three most common injuries were pulmonary contusions, costal fractures, and Magerl A1 vertebral fractures, but the patterns of traumatic injuries on WBCT depended on the children’s age and the trauma mechanism.

• The independent predictors of missed injuries were age ≤ 4 years, number of body parts involved ≥ 2, and total number of injuries ≥ 3.

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95% CI:

95% confidence interval


Abbreviated Injury Scale


Injury Severity Score


Kruskal-Wallis chi-squared statistics


Multisystem trauma


Motor vehicle accident


Odds ratio


Whole-body CT scans


  1. Cunningham RM, Walton MA, Carter PM (2018) The major causes of death in children and adolescents in the United States. N Engl J Med 379:2468–2475.

    Article  PubMed  PubMed Central  Google Scholar 

  2. Nice (2016) Major trauma : assessment and initial management. NICE Guidel

    Google Scholar 

  3. Philipp MO, Kubin K, Hörmann M, Metz VM (2003) Radiological emergency room management with emphasis on multidetector-row CT. Eur J Radiol.

  4. Geyer LL, Körner M, Linsenmaier U et al (2013) Incidence of delayed and missed diagnoses in whole-body multidetector CT in patients with multiple injuries after trauma. Acta Radiol.

  5. Huber-Wagner S, Biberthaler P, Häberle S et al (2013) Whole-body CT in haemodynamically unstable severely injured patients - a retrospective, multicentre study. PLoS One.

  6. Chaumoître K, Merrot T, Petit P, Panuel M (2008) Particularités des traumatismes thoraciques et abdominaux chez l’enfant. J Radiol.

  7. Orliaguet GA, Meyer PG, Blanot S et al (1998) Predictive factors of outcome in severely traumatized children. Anesth Analg.

  8. Javouhey E, Guérin AC, Amoros E et al (2006) Severe outcome of children following trauma resulting from road accidents. Eur J Pediatr.

  9. Desforges JF, Trunkey D (1991) Initial treatment of patients with extensive trauma. N Engl J Med.

  10. Ducrocq SC, Meyer PG, Orliaguet GA et al (2006) Epidemiology and early predictive factors of mortality and outcome in children with traumatic severe brain injury: experience of a French pediatric trauma center. Pediatr Crit Care Med.

  11. Hilbert-Carius P, Hofmann GO, Lefering R et al (2015) Whole-body-CT in severely injured children. Results of Retrospective, Multicenter Study with Patients from the TraumaRegsiter DGU®. Klin Pädiatrie.

  12. Abe T, Aoki M, Deshpande G et al (2019) Is whole-body CT associated with reduced in-hospital mortality in children with trauma? A nationwide study*. Online Clin Investig.

  13. Frellesen C, Klein D, Tischendorf P et al (2018) Indication of whole body computed tomography in pediatric polytrauma patients—diagnostic potential of the Glasgow Coma Scale, the mechanism of injury and clinical examination. Eur J Radiol.

  14. Strohm PC, Uhl M, Hauschild O et al (2008) What is the value of the whole body spiral CT in the primary radiological imaging of severely injured children? Z Orthop Unfall.

  15. Miele V, Di Giampietro I, Ianniello S et al (2014) Diagnostic imaging in pediatric polytrauma management. Radiol Med.

  16. Da Dalt L, Marchi AG, Laudizi L et al (2006) Predictors of intracranial injuries in children after blunt head trauma. Eur J Pediatr.

  17. Hulka F, Mullins RJ, Leonardo V et al (1998) Significance of periteneal fluid as an isolated finding on abdominal computed tomographic scans in pediatric trauma patients. J Trauma.

  18. Neish AS, Taylor GA, Lund DP, Atkinson CC (1998) Effect of CT information on the diagnosis and management of acute abdominal injury in children. Radiology.

  19. Jindal A, Velmahos GC, Rofougaran R (2002) Computed tomography for evaluation of mild to moderate pediatric trauma: are we overusing it? World J Surg.

  20. Pandit V, Michailidou M, Rhee P et al (2016) The use of whole body computed tomography scans in pediatric trauma patients: are there differences among adults and pediatric centers? J Pediatr Surg.

  21. Banaste N, Caurier B, Bratan F et al (2018) Whole-body CT in patients with multiple traumas: factors leading to missed injury. Radiology.

  22. Agostini C, Durieux M, Milot L et al (2008) Value of double reading of whole body CT in polytrauma patients. J Radiol.

  23. Agrawal A, Koundinya DB, Raju JS et al (2017) Utility of contemporaneous dual read in the setting of emergency teleradiology reporting. Emerg Radiol.

  24. Riou B, Thicoïpé M, Atain-Kouadio P et al (2002) Comment évaluer la gravité? SAMU de France. In: SFEM éditions (ed) Actualités en réanimation préhospitalière: le traumatisé grave. Vittel, France, pp 115–12825

  25. SNITEM, Conseil professionnel de la Radiologie (2011) Téléimagerie – Téléradiologie Recommandations du SNITEM et du Conseil professionnel de la radiologie. Accessed 18 Feb 2018

  26. Muhm M, Danko T, Henzler T et al (2015) Pediatric trauma care with computed tomography—criteria for CT scanning. Emerg Radiol.

  27. Association for the Advancement of Automotive Medicine - Committee on Injury Scaling The Abbreviated Injury Scale. Des Plains, IL

  28. Melvin C, Bodley R, Booth A et al (2004) Managing errors in radiology: a working model. Clin Radiol 59:841–845.

    CAS  Article  PubMed  Google Scholar 

  29. National Highway Traffic Safety Administration (2010) Children injured in motor vehicle traffic crashes.

  30. Huelke DF (1998) An overview of anatomical considerations of infants and children in the adult world of automobile safety design. Annu Proc Assoc Adv Automot Med 42:93–113

    PubMed Central  Google Scholar 

  31. Giannakopoulos GF, Saltzherr TP, Beenen LFM et al (2012) Missed injuries during the initial assessment in a cohort of 1124 level-1 trauma patients. Injury 43:1517–1521.

    CAS  Article  PubMed  Google Scholar 

  32. Gates RL, Price M, Cameron DB et al (2019) Non-operative management of solid organ injuries in children: an American Pediatric Surgical Association Outcomes and Evidence Based Practice Committee systematic review. J Pediatr Surg 54:1519–1526.

    Article  PubMed  Google Scholar 

  33. Miller PR, Croce MA, Bee TK et al (2001) ARDS after pulmonary contusion: accurate measurement of contusion volume identifies high-risk patients. J Trauma 51:223–230.

    CAS  Article  PubMed  Google Scholar 

  34. Berbaum KS, El-Khoury GY, Ohashi K et al (2007) Satisfaction of search in multitrauma patients: severity of detected fractures. Acad Radiol.

  35. Meltzer JA, Stone ME, Reddy SH, Silver EJ (2018) Association of whole-body computed tomography with mortality risk in children with blunt trauma. JAMA Pediatr. 172:542–549.

    Article  PubMed  PubMed Central  Google Scholar 

  36. Munk RD, Strohm PC, Saueressig U et al (2009) Effective dose estimation in whole-body multislice CT in paediatric trauma patients. Pediatr Radiol.

  37. Miglioretti DL, Johnson E, Williams A et al (2013) The use of computed tomography in pediatrics and the associated radiation exposure and estimated cancer risk. JAMA Pediatr.

  38. Fenton SJ, Hansen KW, Meyers RL et al (2004) CT scan and the pediatric trauma patient - are we overdoing it? J Pediatr Surg.

  39. Streck CJ Jr, Jewett BM, Wahlquist AH, Gutierrez PS, Russell WS (2012) Evaluation for intra-abdominal injury in children after blunt torso trauma: can we reduce unnecessary abdominal computed tomography by utilizing a clinical prediction model? J Trauma Acute Care Surg 73(2):371–376.

  40. Van Schuppen J, Olthof D, Wilde J et al (2013) Diagnostic accuracy of a step-up imaging strategy in pediatric patients with blunt abdominal trauma. Eur J Radiol.

  41. Hassan N, Butler C, DeCou J et al (2020) Pediatric cervical spine injuries on CT: difference in accuracy of interpretations by pediatric versus non-pediatric radiologists. Emerg Radiol.

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We would like to thank Julien May (DICOM referent, IMADIS Teleradiology) for his technical support and assistance, and all partner centers for their trust and effective collaboration.


The authors state that this work has not received any funding.

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Correspondence to Guillaume Gorincour.

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The scientific guarantor of this publication is Dr Guillaume Gorincour.

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PD, AC, SH, NB, and MS disclosed no relevant relationships.

AD and GG have shares in Deeplink Medical.

Statistics and biometry

One of the authors has significant statistical expertise (AC).

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Written informed consent was not required for this study because of the retrospective nature of this study, and patients were informed about the reuse of their anonymized data.

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Institutional Review Board approval was obtained (CRM-2101-126).

Study subjects or cohorts overlap:

Approximately 200 patients are part of the population studied in the article Banaste et al, Radiology 2018; 00:1-101,


• retrospective

• observational

• multicenter study

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Didion, P., Crombé, A., Dabadie, A. et al. Emergency whole-body CT scans in pediatric patients with trauma: patterns of injuries, yield of dual-phase scanning, and influence of second read on detection of injuries. Eur Radiol (2022).

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  • Multiple trauma
  • Tomography, X-ray computed
  • Whole-body scanning
  • Child