CHEST TRAUMA?

A shortcut review was carried out to establish if CXR had sufficient sensitivity to rule out significant thoracic injury in haemodynamically stable, paediatric patients with a significant mechanism of trauma. No studies were found that directly answered the three-part question, but 13 studies were found which were considered relevant. The author, date and country of publication, patient group studied, study type, relevant outcomes, results and study weaknesses of these papers are tabulated. The clinical bottom line is that important thoracic injuries may not be clinically apparent and that CT scans have a significantly higher sensitivity than CXR in detecting such injuries. CLINICAL SCENARIO A 6-year-old child was brought to hospital as a major trauma having been hit by a reversing car. The actual incident was not witnessed but the tyre tracks across the child’s chest and the petechiae on his face and neck give credence to the theory that the car rolled over him. The child has an obvious head injury with a history of a period of consciousness but is haemo-dynamically stable. After immediate assessment and initial resuscitation you discuss the appropriate imaging with the radiologist. The radiologist agrees to perform a CT of the child’s head and neck but declines to do a CTof the child’s thorax. He quotes the Royal College of Radiology guidelines that state that for children who have suffered major trauma, CT scans of the thorax are not indicated for the haemodynamically stable child with a normal CX