Original Contribution Computed tomography is not justified in every pediatric blunt trauma patient with a suspicious mechanism of injury ☆ Yehuda Hershkovitz, MD a , Itai Zoarets, MD a , Albert Stepansky, MD a , Eran Kozer, MD b , Zahar Shapira, MD a , Baruch Klin, MD c , Ariel Halevy, MD a , Igor Jeroukhimov, MD a, ⁎ a Division of Surgery, Assaf Harofeh Medical Center, Zerifin 70300, affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Israel b Pediatric Emergency Unit, Assaf Harofeh Medical Center, Zerifin 70300, affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Israel c Department of Pediatric Surgery, Assaf Harofeh Medical Center, Zerifin 70300, affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Israel abstract article info Article history: Received 19 March 2014 Accepted 7 April 2014 Available online xxxx Objective: Computed tomography (CT) has become an important tool for the diagnosis of intra-abdominal and chest injuries in patients with blunt trauma. The role of CT in conscious asymptomatic patients with a suspicious mechanism of injury remains controversial. This controversy intensifies in the management of pediatric blunt trauma patients, who are much more susceptible to radiation exposure. The objective of this study was to evaluate the role of abdominal and chest CT imaging in asymptomatic pediatric patients with a suspicious mechanism of injury. Methods: Forty-two pediatric patients up to 15 years old were prospectively enrolled. All patients presented with a suspicious mechanism of blunt trauma and multisystem injury. They were neurologically intact and had no signs of injury to the abdomen or chest. Patients underwent CT imaging of the chest and abdomen as part of the initial evaluation. Results: Thirty-one patients (74%) had a normal CT scan. Two patients of 11 with an abnormal CT scan required a change in management and were referred for observation in the Intensive Care Unit. None of the patients required surgical intervention. Conclusion: The routine use of CT in asymptomatic pediatric patients with a suspicious mechanism of blunt trauma injury is not justified. © 2014 Elsevier Inc. All rights reserved. 1. Introduction A normal physical examination by itself has been shown to be unreliable for excluding intraabdominal injury in multi-trauma adult patients [1–6]. Since the 1970s, computed tomography (CT) imaging has become the mainstay diagnostic evaluation of blunt trauma patients [1,2,4,7–9]. It is generally accepted that hemodynamically stable patients with abnormal physical examination undergo CT imaging, as well as patients with a depressed level of consciousness [3,10]. Controversy exists regarding awake, clinically evaluable patients with no obvious signs of internal organ injury. In the last years, a number of studies have assessed the role of CT scans in the evaluation of asymptomatic trauma patients with a high suspicion for internal organ injury according to the mechanism of trauma [4,11,12]. It was shown that in 10% to 20% of such patients, the management plan changed because of the CT results [3,4,12,13]. Thus, liberal use of CT scans was recommended [3,6,8,9]. Exposure to ionizing radiation is considered the major disadvantage of CT imaging. The risk of radiation induced malignancy has been shown by many authors [4,5,7,8,13,14]. An inverse relationship has been reported between the risk of radiation and the age of the exposed patient. Children are up to 10 times more sensitive to ionizing radiation than adults [5,11,14–16], and the risk of radiation induced mortality ranges from 1/1000 to 1/2000 [5,11]. The purpose of this study was to evaluate the role of abdominal and chest CT imaging in pediatric patients with a suspicious mechanism of injury, who are hemodynamically stable and have no obvious signs of chest or abdominal trauma. 2. Patients and methods A prospective observational study was performed at a high volume level II trauma center located in central Israel from January 1, 2007, to June 30, 2009. This study was conducted with institutional review board approval. Only patients whose legal guardian signed an inform consent were enrolled. American Journal of Emergency Medicine xxx (2014) xxx–xxx ☆ Disclosure: The authors declare that they have no commercial associations, financial disclosures, or other competing interests with regard to this article. There are no sources of funding. ⁎ Corresponding author at: Division of Surgery, Assaf Harofeh Medical Center, Zerifin 70300, Israel. Tel.: +972 8 9778276; fax: +972 8 9778399. E-mail address: igorjer65@gmail.com (I. Jeroukhimov). http://dx.doi.org/10.1016/j.ajem.2014.04.024 0735-6757/© 2014 Elsevier Inc. All rights reserved. Contents lists available at ScienceDirect American Journal of Emergency Medicine journal homepage: www.elsevier.com/locate/ajem Please cite this article as: Hershkovitz Y, et al, Computed tomography is not justified in every pediatric blunt trauma patient with a suspicious mechanism of injury, Am J Emerg Med (2014), http://dx.doi.org/10.1016/j.ajem.2014.04.024