From the Department of Emergency Medicine, Corewell Health Helen DeVos Children's Hospital, Grand Rapids, MI.
Pediatr Emerg Care. 2024 Jan 1;40(1):10-15. doi: 10.1097/PEC.0000000000003102.
Blunt trauma in pediatric patients accounts for a significant proportion of pediatric death from traumatic injury. Currently, there are no clinical decision-making tools available to guide imaging choice in the evaluation of pediatric patients with blunt thoracic trauma (BTT). This study aimed to analyze the rates of missed major intrathoracic injuries on chest x-ray (CXR) and identify clinical risk factors associated with major intrathoracic injuries to formulate a clinical decision-making tool for computed tomography (CT) use in pediatric patients with BTT.
We performed a retrospective single-center study using an institutional trauma database of pediatric patients. Inclusion criteria included age, blunt trauma, and patients who received a CXR and thoracic CT within 24 hours of presentation. Thoracic CT findings were graded as major, minor, or none, and comparison CXR was used to determine the rate of missed thoracic injuries. Eighty-four patient variables were then collected, and clinically relevant variables associated with major intrathoracic injuries were placed in a logistic regression model to determine the best predictors of major injury in pediatric BTT patients.
A total of 180 patients (48.3%) had CXR that missed an injury that was seen on thoracic CT. In our cohort, 20 patients (5.4%) had major injuries that were missed on CXR. Characteristics correlating with major thoracic injuries were older age (odds ratio [OR], 1.125; 95% confidence interval [CI], 1.015-1.247), chest pain (OR, 4.907; 95% CI, 2.173-11.083), abnormal chest auscultation (OR, 3.564; 95% CI, 1.406-9.035), and tachycardia (OR, 2.876; 95% CI, 1.256-6.586). Using these 4 variables, receiver operating characteristic analysis revealed an area under the curve of 0.7903.
Pediatric BTT patients older than 15 years with tachycardia, chest pain, or abnormal chest auscultation are at increased risk for major intrathoracic injuries and may benefit from thoracic CT.
儿童钝性创伤占儿童创伤性损伤死亡的很大比例。目前，尚无临床决策工具可用于指导评估儿童钝性胸部创伤（BTT）患者的影像学选择。本研究旨在分析胸部 X 线（CXR）漏诊的主要胸腔内损伤的发生率，并确定与主要胸腔内损伤相关的临床危险因素，以便为 BTT 患儿制定 CT 使用的临床决策工具。
我们使用机构创伤数据库进行了回顾性单中心研究，纳入标准为年龄、钝性创伤以及在就诊后 24 小时内接受 CXR 和胸部 CT 的患者。将胸部 CT 结果分级为主要、次要或无，比较 CXR 以确定胸腔损伤的漏诊率。然后收集了 84 个患者变量，并将与主要胸腔内损伤相关的临床相关变量纳入逻辑回归模型，以确定 BTT 患儿中主要损伤的最佳预测因子。
共有 180 名患者（48.3%）的 CXR 漏诊了胸部 CT 上可见的损伤。在我们的队列中，有 20 名患者（5.4%）的 CXR 漏诊了主要损伤。与主要胸部损伤相关的特征是年龄较大（优势比[OR]，1.125；95%置信区间[CI]，1.015-1.247）、胸痛（OR，4.907；95% CI，2.173-11.083）、异常胸部听诊（OR，3.564；95% CI，1.406-9.035）和心动过速（OR，2.876；95% CI，1.256-6.586）。使用这 4 个变量，受试者工作特征分析显示曲线下面积为 0.7903。
年龄大于 15 岁、心动过速、胸痛或异常胸部听诊的 BTT 患儿发生主要胸腔内损伤的风险增加，可能受益于胸部 CT。
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