Skip to main content

Advertisement

SpringerLink
Log in

Diagnostic imaging in pediatric polytrauma management

  • EMERGENCY RADIOLOGY
  • Published:
La radiologia medica Aims and scope Submit manuscript

Abstract

Trauma is the cause of over 45 % of deaths in children aged 1 to 14 years. Since multiple injuries are common among children, the emergency physician has to assess all the organs of a high-energy injured child, independent of mechanism of the trauma. Even if the principles of polytrauma management are identical both in children and in adults, the optimal pediatric patient care requires a specific understanding of some important anatomical, physiological, and psychological differences that play a significant role in the assessment and management of a pediatric patient. Emergency Radiology already plays a crucial role in the diagnostic process of a polytraumatized child according to the primary survey, through the use of multiple imaging modalities. Radiological and Ultrasound examinations play a basic role in the hemodynamically unstable patients. In the hemodynamically stable patients whole-body CT scanning is the most immediate radiological procedure that allows the examination of all the body parts of a polytraumatized child, reducing the number of minor injuries that might otherwise be neglected.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7
Fig. 8
Fig. 9
Fig. 10
Fig. 11
Fig. 12
Fig. 13
Fig. 14
Fig. 15

Similar content being viewed by others

References

  1. Jaffe D (1991) Emergency management of blunt trauma in children. N Engl J Med 324:1477–1482

    Article  CAS  PubMed  Google Scholar 

  2. Minino A, Heron M, Smith B (2006) Deaths: final data for 2004. Nat Vital Stat Rep 54:1–49

    Google Scholar 

  3. Peclet MH, Newman KD, Eichelberger MR et al (1990) Patterns of injury in children. J Pediatr Surg 25:85–90

    Article  CAS  PubMed  Google Scholar 

  4. Sieben RL, Leavitt JD, French JH (1971) Falls as childhood accidents: an increasing urban risk. Pediatrics 47:886

    CAS  PubMed  Google Scholar 

  5. Ablu-Jaude WA (1996) Indicators of genitourinary tract injury or anomaly in cases of pediatric blunt trauma. J Pediatr Surg 31:86

    Article  Google Scholar 

  6. Corey TS (1992) Infant deaths due to unintentional injury: an 11-year autopsy review. Am J Dis Child 146:968–971

    Article  CAS  PubMed  Google Scholar 

  7. King DR (1985) Trauma in infancy and childhood: initial evaluation and management. Pediatr Clin N Am 32:1299–1310

    CAS  Google Scholar 

  8. Rutland-Brown W, Langlois JA, Thomas KE, Xi YL (2006) Incidence of traumatic brain injury in the United States, 2003. J Head Trauma Rehabil 21:544–548

    Article  PubMed  Google Scholar 

  9. Sharples PM, Storey A, Aynsley-Gree A, Eyre JA (1990) Avoidable factors contributing to death of children with head injury. BMJ 300:87–91

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  10. Avarello JT, Cantor RM (2007) Pediatric major trauma: an approach to evaluation and management. Emerg Med Clin North Am 25:803–836

    Article  PubMed  Google Scholar 

  11. Miele V, Andreoli C, Grassi R (2006) The management of emergency radiology: key facts. Eur J Radiol 59:311–314

    Article  PubMed  Google Scholar 

  12. Gausche M, Lewis RJ, Stratton SJ et al (2000) Effect of out-of-hospital pediatric endotracheal intubation on survival and neurological outcome: a controlled clinical trial. JAMA 283:783–789

    Article  CAS  PubMed  Google Scholar 

  13. Kleinman ME, Chameides L, Schexnayder SM et al (2010) Part 14: pediatric advanced life support: 2010 American Heart Association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care. Circulation 122:876–908

    Article  Google Scholar 

  14. Kanter RK, Zimmerman JJ, Strauss RH et al (1986) Pediatric emergency intravenous access. Evaluation of a protocol. Am J Dis Child 140:132–134

    Article  CAS  PubMed  Google Scholar 

  15. Jakob H, Lustenberger T, Schneidmüller D et al (2010) Pediatric polytrauma management. Eur J Trauma Emerg Surg 36:325–338

    Article  Google Scholar 

  16. Eichelberger MR, Mngubat EA, Sacco WJ et al (1988) Outcome analysis of blunt injury in children. Trauma 28:1109–1115

    Article  CAS  Google Scholar 

  17. Shorr RM, Crittenden M, Indeck M et al (1987) Blunt thoracic trauma: analysis of 515 patients. Ann Surg 206:200–205

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  18. Hoyt DB, Coimbra R, Potenza B et al (2003) A twelve-year analysis of disease and provider complications on an organized Level I trauma service: as good as it gets? J Trauma 54:25–37

    Article  Google Scholar 

  19. Scaglione M, Pinto A, Pedrosa I et al (2008) Multi-detector row computed tomography and blunt chest trauma. Eur J Radiol 65:377–388

  20. Cooper GJ, Taylor DE (1989) Biophysics of impact injury to the chest and abdomen. J R Army Med Corps 135:58–67

    Article  CAS  PubMed  Google Scholar 

  21. Zinck SE, Primack SL (2000) Radiographic and CT findings in blunt chest trauma. J Thorac Imaging 15:87–96

    Article  CAS  PubMed  Google Scholar 

  22. Ball CG, Kirkpatrick AW, Laupland KB et al (2005) Incidence, risk factors and outcomes for occult pneumothoraces in victim of major trauma. J Trauma 59:917–924

    Article  PubMed  Google Scholar 

  23. Ma Neff, Monk JS Jr, Peters K et al (2000) Detection of occult pneumothoraces on abdominal computed tomographic scans in trauma patients. J Trauma 49:281–285

    Article  Google Scholar 

  24. Kg Bridges, Welch G, Silver M et al (1993) Detection of occult pneumothorax in multiple trauma patients. J Emer Med 11:179–186

    Article  Google Scholar 

  25. Ball CG, Kirkpatrick AW, Laupland KB et al (2005) Factors related to the failure of radiographics recognition of occult post-traumatic pneumothoraces. Am J Surg 189:541–546

    Article  PubMed  Google Scholar 

  26. Collins JA, Samra GS (1998) Failure of chest X-rays to diagnose pneumothoraces after blunt trauma. Anaesthesia 53:74–78

    Article  CAS  PubMed  Google Scholar 

  27. Gordon R (2008) The deep sulcus sign. Radiology 136:25

    Article  Google Scholar 

  28. Gilbert TB, McGrath BJ (1994) Tension pneumothorax: etiology, diagnosis, pathophysiology, and management. J Intensive Care Med 9:139

    Google Scholar 

  29. Woodring JH (1984) Recognition of pleural effusion on supine radiographs: how much fluid is required? Am J Roentnol 142:59–64

    Article  CAS  Google Scholar 

  30. Henschke CL, Davis SD, Romano RM et al (1989) Pleural effusion: pathogenesis, radiolog evaluation, and therapy. J Thorac Imaging 4:49–60

    Article  CAS  PubMed  Google Scholar 

  31. Sivit CJ, Taylor GA, Eichelberger MR (1989) Chest injury in children with blunt abdominal trauma: evaluation with CT. Radiology 171:815–818

    Article  CAS  PubMed  Google Scholar 

  32. Cohen MC (1997) Pulmonary contusion: review of the clinical entity. J Trauma 42:973–979

    Article  Google Scholar 

  33. Clark GC, Schecter WP, Trunkey DD (1988) Variables affecting outcome in blunt chest trauma: flail chest vs pulmonary contusion. J Trauma 28:298–304

    Article  CAS  PubMed  Google Scholar 

  34. Wanek S, Mayberry JC (2004) Blunt thoracic trauma: flail chest, pulmonary contusion, and blast injury. Crit Care Clin 20:71–81

    Article  PubMed  Google Scholar 

  35. 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

    Article  CAS  PubMed  Google Scholar 

  36. Exadaktylos AK, Sclaba G, Schmid SW et al (2001) Do we really need routine computed tomographic scanning in the primary evaluation of blunt chest trauma in patients with “normal” chest radiograph? J Trauma 51:1173–1176

    Article  CAS  PubMed  Google Scholar 

  37. Manson D, Babyn PS et al (1993) CT of blunt chest trauma in children. Pediatr Radiol 23:1–5

    Article  CAS  PubMed  Google Scholar 

  38. Costantino M, Gosselin MV, Primack SL (2006) The ABC’s of thoracic trauma imaging. Semin Roentgenol 41:209–225

    Article  PubMed  Google Scholar 

  39. Glinz W (1986) Problem caused by the unstable thoracic wall and by cardiac injury due to blunt injury. Injury 17:322–326

    Article  CAS  PubMed  Google Scholar 

  40. Mirvis SE, Shamuganathan K, Miller BH et al (1996) Traumatic aortic injury: diagnosis with contrast-enhanced thoracic CT 5 year experience at a major trauma center. Radiology 200:413–422

    Article  CAS  PubMed  Google Scholar 

  41. Moore EE, Malangoni MA, Cogbill TH et al (1994) Organ injury scaling. IV: thoracic vascular, lung, cardiac and diaphragm. J Trauma 36:299–300

    Article  CAS  PubMed  Google Scholar 

  42. Newman RJ, Rastogi S (1984) Rupture of the thoracic aorta and its relationship to road traffic accident characteristics. Injury 15:296–299

    Article  CAS  PubMed  Google Scholar 

  43. Shamuganathan K, Mirvis SE (1999) Imaging diagnosis of non aortic thoracic injury. Radiolo Clin North Am 37:533–551

    Article  Google Scholar 

  44. Hamilton JD, Kumaravel M, Censullo ML et al (2008) Multidetector CT evaluation of active extravasation in blunt abdominal and pelvic trauma patients. Radiographics 28:1603–1616

    Article  PubMed  Google Scholar 

  45. Ianniello S, Di Giacomo V, Sessa B, Miele V (2014) First-line sonographic diagnosis of pneumothorax in major trauma: accuracy of E-FAST and comparison with multidetector computed tomography. Radiol Med 119(9):674–680

    Article  PubMed  Google Scholar 

  46. Volpicelli G (2011) Sonographic diagnosis of pneumothorax. Intensive Care Med 37:224

    Article  PubMed  Google Scholar 

  47. Soldati G, Testa A, Pignataro G, Portale G, Biasucci DG, Leone A, Silveri NG (2006) The ultrasonographic deep sulcus sign in traumatic pneumothorax. Ultrasound Med Biol 32:1157–1163

    Article  PubMed  Google Scholar 

  48. Ball CG, Kirkpatrick AW, Laupland KB et al (2005) Factors related to the failure of radiographic recognition of occult post traumatic pneumothoraces. Am J Surg 189:541–546

    Article  PubMed  Google Scholar 

  49. Tocino IM, Miller MH, Fairfax WR (1985) Distribution of pneumothorax in the supine and semi-recumbent critically ill adult. AJR Am J Roentgenol 144:901–905

    Article  CAS  PubMed  Google Scholar 

  50. Lichtenstein DA, Mezie`re G, Lascols N, Biderman P, Courret JP, Gepner A, Goldstein I, Tenoudji-Cohen M (2005) Ultrasound diagnosis of occult pneumothorax. Crit Care Med 33:1231–1238

    Article  PubMed  Google Scholar 

  51. Volpicelli G, Mussa A, Garofalo G, Cardinale L, Casoli G, Perotto F, Fava C, Frascisco M (2006) Bedside lung ultrasound in the assessment of alveolar-interstitial syndrome. Am J Emerg Med 24:689–696

    Article  PubMed  Google Scholar 

  52. Reissig A, Kroegel C (2003) Transthoracic sonography of diffuse parenchymal lung disease. The role of comet tail artifacts. J Ultrasound Med 22:173–180

    PubMed  Google Scholar 

  53. Baker N, Woolridge D (2013) Emergency concepts in pediatric emergency radiology. Pediatric Clin N Am 60:1139–1151

    Article  Google Scholar 

  54. Ptak T, Rhea JT, Novelline RA (2003) Radiation dose is reduced with a single-pass whole body multi-detector row CT trauma protocol compared with a conventional segmented method: initial experience. Radiology 229:902–905

    Article  PubMed  Google Scholar 

  55. Kalra MK, Prasad S, Sain S et al (2002) Clinical comparison of standard-dose and 50% reduced-dose abdominal CT: effect on image quality. Am J Roentgenol 179:1101–1106

    Article  Google Scholar 

  56. Kalra MK, Rizzo SMR, Novelline RA (2005) Reducing radiation dose in emergency computed tomography with automatic exposure control techniques. Emerg Radiol 11:267–274

    Article  PubMed  Google Scholar 

  57. McCollough CH, Bruesewitz MR, Kofler JM Jr (2006) CT dose reduction and dose management tools: overview of available options. Radiographics 26(2):503–512

    Article  PubMed  Google Scholar 

  58. Miele V, Pinto A, Rotondo A (2012) Acute abdomen: rational use of US, MDCT, and MRI. Springer, Berlin Heidelberg, pp 17–29

    Google Scholar 

Download references

Conflict of interest

The authors declare no conflict of interest.

Author information

Authors and Affiliations

  1. Cardiovascular and Emergency Radiology Department, S. Camillo-Forlanini Hospital, 87, Circonvallazione Gianicolense, 00152, Rome, Italy

    Vittorio Miele, Ilenia Di Giampietro, Stefania Ianniello & Margherita Trinci

  2. Department of Diagnostic Radiological Imaging, Marcianise Hospital, Marcianise, CE, Italy

    Fabio Pinto

Authors
  1. Vittorio Miele
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Ilenia Di Giampietro
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Stefania Ianniello
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Fabio Pinto
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Margherita Trinci
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Vittorio Miele.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Miele, V., Di Giampietro, I., Ianniello, S. et al. Diagnostic imaging in pediatric polytrauma management. Radiol med 120, 33–49 (2015). https://doi.org/10.1007/s11547-014-0469-x

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11547-014-0469-x

Keywords

Search

Navigation