Butchy M Virginia, Williamson John, Lou Johanna, Williams Jennifer, Kota Rasagnya, Kazmi Khuram S, Katz Douglas, Moront Matthew, Lindholm Erika B
Department of Surgery, Cooper University Hospital, Camden, NJ, USA.
Cooper Medical School at Rowan University, Camden, NJ, USA.
Am Surg. 2025 Feb;91(2):253-258. doi: 10.1177/00031348241290611. Epub 2024 Oct 8.
Head trauma is responsible for significant morbidity and mortality in the pediatric trauma population. There are validated guidelines which indicate the necessity for computed tomography of the head (CTH), but the indication for a dedicated CT of the facial bones (CTF) is less clear. We sought to identify our population of head trauma patients who would clinically benefit from the addition of CTF.
Using the electronic medical record, pediatric trauma patients who underwent CTH and/or CTF from 2016 to 2021 were identified. We collected information on demographics, traumatic mechanism, subspecialty consultation, and operative and procedural interventions.
2117 pediatric patients were evaluated. A total of 372 patients received CTH and 173 patients received both CTH + CTF. Patients with CTH + CTF were older ( < 0.001), involved in high-velocity blunt trauma ( < 0.001), and had a longer length of stay ( < 0.001). There were no fractures identified in 73 (42.2%) patients with both CTH + CTF. Of patients with fractures, there were 204 fractures identified and 73.0% (149/204) of fractures were seen on both the CTH + CTF. There were 19.6% (40/204) read only on CTF and 10 patients (5.7%) had a fracture requiring intervention. 8 of the 10 fractures requiring operative intervention were mandibular bone fractures.
Computed tomography of the head can be used as a screening tool for facial fractures. A negative CTH can eliminate the need for additional radiation from a CTF. Computed tomography of the facial bones will identify more fractures, but few requiring intervention. We suggest that CTF be limited to a subset of pediatric trauma patients with facial injury.
头部创伤是儿童创伤人群发病和死亡的重要原因。已有经过验证的指南表明有必要进行头部计算机断层扫描（CTH），但对面部骨骼专用CT（CTF）的指征尚不太明确。我们试图确定在临床上能从增加CTF检查中获益的头部创伤患者群体。
利用电子病历，确定2016年至2021年期间接受CTH和/或CTF检查的儿童创伤患者。我们收集了人口统计学、创伤机制、专科会诊以及手术和操作干预等方面的信息。
共评估了2117例儿科患者。共有372例患者接受了CTH检查，173例患者同时接受了CTH + CTF检查。接受CTH + CTF检查的患者年龄较大（<0.001），遭受高速钝性创伤（<0.001），住院时间较长（<0.001）。在173例同时接受CTH + CTF检查的患者中，73例（42.2%）未发现骨折。在有骨折的患者中，共发现204处骨折，其中73.0%（149/204）的骨折在CTH + CTF检查中均能看到。仅在CTF检查中发现的骨折占19.6%（40/204），有10例患者（5.7%）的骨折需要干预。10例需要手术干预的骨折中有8例是下颌骨骨折。
头部计算机断层扫描可作为面部骨折的筛查工具。CTH检查结果为阴性可避免因CTF检查而额外接受辐射。面部骨骼计算机断层扫描能发现更多骨折，但需要干预的较少。我们建议CTF检查应限于有面部损伤的儿童创伤患者亚组。
