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Pediatric Trauma Computed Tomography: A Comprehensive Guide

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Trauma Computed Tomography

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Abstract

Trauma is the leading cause of morbidity and mortality in children over 1 year of age, with a vast majority of injuries being blunt traumatic injuries. CT is an important tool in evaluation and management of pediatric trauma. However, because children are at increased risk of harmful radiation effects, CT must be used more cautiously, and protocols must be modified to decrease radiation dose. There are important differences in patterns of pediatric injuries than adults owing to different body proportions and the immature skeleton. The relatively larger head size, hypermobility of the cervical spine, and ligamentous laxity makes young children more prone to upper cervical spine injuries, dislocation injuries, and spinal cord injuries without bony injury. Children are also more susceptible to blunt chest and abdominal injuries than adults because of the larger relative size of the organs compared to the torso size and paucity of protective intraabdominal fat. Trauma grading of solid organ injuries in children follows the AAST grading scale. The growing skeleton creates unique points of strengths and weaknesses. Fractures tend to occur at the weakest point in the growing bones at the physes and apophyses. The bones are also more pliable and can buckle or bend before fracturing, resulting in buckle, bowing, or incomplete fractures. Differentiating accidental trauma from non-accidental trauma can be challenging but is a critically important distinction with important legal implications. Imaging plays an important role in identification of injuries that may not be outwardly apparent. Certain patterns of head and spine injuries in infants and young children are more highly associated with non-accidental trauma. Awareness of mimics of abusive head trauma is critical to avoid erroneously diagnosing non-accidental trauma. No specific abdominal injury is indicative of non-accidental trauma though pancreatic and hollow viscus injury are more commonly associated with non-accidental trauma. Fractures also occur in nearly half of abused children. While skeletal survey remains the gold standard in the evaluation for fractures, though low dose CT has recently been used to better assess for rib fractures. This chapter reviews CT findings of both accidental and non-accidental pediatric traumatic injuries, reviews common mimics that may present diagnostic pitfalls, and reviews specific pediatric CT protocols.

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Author notes

  1. Neal Joshi and Kathleen E. Schenker contributed equally.

Authors and Affiliations

  1. Department of Radiology, Thomas Jefferson University Hospital, Philadelphia, PA, USA

    Neal Joshi

  2. Department of Medical Imaging, Nemours Children’s Hospital, Wilmington, DE, USA

    Kathleen E. Schenker, Rahul Nikam & Vinay Kandula

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  1. Neal Joshi
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  2. Kathleen E. Schenker
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  3. Rahul Nikam
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  4. Vinay Kandula
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Corresponding author

Correspondence to Vinay Kandula .

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Editors and Affiliations

  1. Department of Medical Imaging, Penn Presbyterian Medical Center, Philadelphia, PA, USA

    Friedrich Knollmann

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Joshi, N., Schenker, K.E., Nikam, R., Kandula, V. (2023). Pediatric Trauma Computed Tomography: A Comprehensive Guide. In: Knollmann, F. (eds) Trauma Computed Tomography. Springer, Cham. https://doi.org/10.1007/978-3-031-45746-3_12

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