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Pediatric trauma care with computed tomography—criteria for CT scanning

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Abstract

Trauma centers, trauma management concepts, as well as integration of whole-body computed tomography (CT) reduced mortality significantly. The accuracy of a trauma care algorithm with emergency CT in children was evaluated. Data of 71 children with emergency CT were recorded retrospectively. In addition to epidemiological data admission date, kind of CT scan, mechanism of injury, missed diagnoses, injury severity score (ISS), admission to and time on intensive care unit (ICU), and time of hospitalization were observed. The algorithm for CT scanning was based on mechanism of injury, pattern of injury, and altered vital signs. Sixty-nine percent of the children reached the ER during on-call service hours. A percentage of 32.4 received a whole-body scan and 67.6 % a cranial scan. The mean ER ISS was 9.9 points (1–57). Children have different trauma mechanisms compared to adults. A percentage of 33.8 of the children had relevant trauma related findings in the CT scan. In 2 children, (2.8 %) 3 diagnoses (2.2 %) were initially missed. After reevaluation of the CT data, all diagnoses were identified. Thus, the accuracy of our algorithm in children was 100 %. In children, our algorithm detected all injuries, but only one third of the children had relevant trauma related findings in the CT scan. In order to reduce radiation exposure but preserve the advantages of CT, a new algorithm was developed with more flexibility taking the child’s age and mental status more into account as well as clinical findings. The mechanism of injury itself is not anymore an indication for CT scanning.

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Conflicts of interest

The authors declare that they have no conflict of interest.

Funding

Dr. Henzler has speaker agreements with Siemens Healtcare Sector and Bracco. Dr. Henzler’s institution has institutional research agreements with Siemens Healthcare Sector.

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Authors and Affiliations

  1. Department of Trauma and Orthopedic Surgery; Westpfalz-Klinikum Kaiserslautern, Medical Faculty Mannheim, University of Heidelberg and University of Mainz, Hellmut-Hartert-Str. 1, D-67655, Kaiserslautern, Germany

    Markus Muhm, Tim Danko, Hartmut Winkler & Thomas Ruffing

  2. Medical Faculty Mannheim, University of Heidelberg, Heidelberg, Germany

    Markus Muhm & Hartmut Winkler

  3. Institute of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Medical Faculty Mannheim, University of Heidelberg, Heidelberg, Germany

    Thomas Henzler

  4. DENIT – German Institute for Emergency Medicine and Information Technology, Fraunhofer Institute for Experimental Software Engineering (IESE), Kaiserslautern, Germany

    Thomas Luiz

Authors
  1. Markus Muhm
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  2. Tim Danko
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  3. Thomas Henzler
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  4. Thomas Luiz
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  5. Hartmut Winkler
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  6. Thomas Ruffing
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Correspondence to Markus Muhm.

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Muhm, M., Danko, T., Henzler, T. et al. Pediatric trauma care with computed tomography—criteria for CT scanning. Emerg Radiol 22, 613–621 (2015). https://doi.org/10.1007/s10140-015-1332-7

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  • DOI: https://doi.org/10.1007/s10140-015-1332-7

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