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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

Abstract

Objectives

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.

Methods

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.

Results

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).

Conclusion

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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Abbreviations

95% CI:

95% confidence interval

AIS:

Abbreviated Injury Scale

ISS:

Injury Severity Score

K:

Kruskal-Wallis chi-squared statistics

MT:

Multisystem trauma

MVA:

Motor vehicle accident

OR:

Odds ratio

WBCT:

Whole-body CT scans

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Acknowledgements

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.

Funding

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

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Authors

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Correspondence to Guillaume Gorincour.

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Guarantor

The scientific guarantor of this publication is Dr Guillaume Gorincour.

Conflict of interest

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).

Informed consent

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.

Ethical approval

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, https://doi.org/10.1148/radiol.2018180492.

Methodology

• 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). https://doi.org/10.1007/s00330-022-08878-1

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  • DOI: https://doi.org/10.1007/s00330-022-08878-1

Keywords

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