717 - Chest CT in Stable Pediatric Blunt Trauma: Limited Clinical Utility Despite Frequent Use

Publication Number: 3694.717

Josh Dysthe, University of Minnesota Masonic Children's Hospital, Minneapolis, MN, United States; Henry W. Ortega, Children’s Minnesota, Minneapolis, MN, United States; Scott Lunos, University of Minnesota, Minneapolis, MN, United States; Shannon Olsen, University of Minnesota Masonic Children's Hospital, Minneapolis, MN, United States; Bradley J. Segura, University of Minnesota Masonic Children's Hospital, Minneapolis, MN, United States; Jeffrey Louie, University of Minnesota, Minneapolis, MN, United States

Background: Chest computed tomography (CT) is frequently used to evaluate pediatric blunt trauma. However, the American College of Surgeons (ACS) Advanced Trauma Life Support (ATLS®) guidelines recommend chest radiography first, reserving CT for concerning findings. CT use in children raises concern because of their greater sensitivity to radiation and the potential for long-term cancer risk.

Objective: We sought out to determine if chest CT use in clinically stable pediatric patients presenting with blunt force trauma changed their management in the emergency department or resulted in an emergent procedure or surgery.

Design/Methods: We reviewed pediatric trauma patients who underwent chest CT across a seven-hospital system between April 2022 and December 2024. Demographics, presentation, imaging type, and outcomes were analyzed, with a focus on clinically stable children.

Results: Sixty-four children underwent chest CT. The median age was 15 years (IQR 12–16), and all were clinically stable with normal vital signs; the median Injury Severity Score was 5 (IQR 2–9). Most scans were chest–abdomen–pelvis (CAP) CTs (90.6%). Forty-nine scans (77%) showed no thoracic abnormalities. The few positive findings were minor, including small pneumothoraxes, pulmonary contusions, or isolated fractures, none of which led to acute intervention. The only clinically significant injury, a small pneumothorax, was visible on both chest radiograph and CT. Six isolated chest CTs were obtained for suspected vascular injury; none changed management. No patient required intubation, emergent procedures, surgery, or died. Thirteen patients (20%) were transferred to higher-level centers, but all remained stable without operative management from the emergency department.

Conclusion(s): In stable pediatric trauma patients, chest CT rarely revealed new or actionable findings. Most scans were normal, and none changed acute care. These results argue strongly against routine CT in this setting. Greater reliance on chest radiography and clinical assessment, as recommended by ACS guidelines, would reduce unnecessary CT use, radiation exposure, and potential cost.