Limiting chest computed tomography in the evaluation of pediatric thoracic trauma.

Background: Computed tomography (CT) chest is overused in blunt pediatric thoracic trauma. CT chest adds to the diagnosis of thoracic injury but rarely changes patient management. We sought to identify a subset of blunt pediatric trauma patients who would benefit from a screening CT chest based on their admission chest X-ray (CXR) findings. We hypothesize that limiting CT chest to patients with an abnormal mediastinal silhouette identifies intra-thoracic vascular injuries not otherwise seen on CXR. Methods: All blunt trauma activations that underwent an admission CXR at our level 1 pediatric trauma center from 2005-2013 were retrospectively reviewed. Patients who had a CT chest were evaluated for added diagnoses and change in management after CT. Results: An admission CXR was performed in 1035 patients. 139 patients had a CT and the diagnosis of intra-thoracic injury was added in 42% of patients. CT chest significantly increased the diagnosis of contusion or atelectasis (30.3% vs 60.4%, p

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