• Y M Liu, M C Avanis, E Thorpe, J Masters, and M Vaidya.
• Paediatric Critical Care, The Royal London Hospital, London, United Kingdom.
• Emerg Med J. 2013 Oct 1;30(10):876-7.

Objectives & BackgroundComputed tomography (CT) is becoming increasingly popular as a primary imaging modality in adult trauma patients. This study aims to examine the added value of thoracic CT (TCT) in the context of paediatric trauma.MethodsRetrospective review of the case notes of 182 consecutive paediatric trauma patients aged 16 and younger who received a chest X-ray (CXR) prior to TCT between January 2010 and April 2012 at a large tertiary paediatric trauma centre in East London.ResultsThe main mechanisms of injury involved were road traffic accidents (50%), stab injuries (31%), and falls (14%). One hundred and twenty one patients (66%) underwent a TCT scan following a normal CXR. Of these, thirty four (28%) patients had new injuries detected. These included lung contusions (n=20), small pneumothoraces (n=5) and rib fractures (n=3). Of the 61 (34%) patients that had a TCT scan following an abnormal CXR, 26 (43%) had additional injuries detected. These included lung contusions (n=8), fractured ribs (n=6) and small pneumothoraces (n=6). The additional information from the TCT did not alter clinical management in any of the above cases.ConclusionThis study indicates a need for a comprehensive guideline for imaging in paediatric trauma, where the use of TCT is limited to specific patients, especially in view of the health implications that CT poses and source of financial burden for the NHS.

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