532 - There is Limited Value of Routine Chest X-ray in Stable Pediatric Trauma Patients

Publication Number: 532.6604

Theodore R. Parks, VCUHS, North Chesterfield, VA, United States; Allison Shaw, Virginia Commonwealth University School of Medicine, Henrico, VA, United States; Jason P. Sulkowski, Children's Hospital of Richmond at VCU, Richmond, VA, United States; Erin Dunbar, Virginia Commonwealth University School of Medicine, Richmond, VA, United States; Jeffrey H. Haynes, Childrens Hospital of Richmond/VCU, richmond, VA, United States; Jeremy Rice, Virginia Commonwealth University School of Medicine, Richmond, VA, United States; Benjamin Bane, Virginia Commonwealth University School of Medicine, Richmond, VA, United States

Background: A chest radiograph is a standard component of a patient evaluation in the setting of a trauma team activation at our institution. However, in less severely injured (i.e., tier II) trauma patients, the utility of chest x-ray as a screening tool has not been well described in the pediatric population.

Objective: Determine the frequency of acute traumatic findings on chest radiographs obtained in resuscitation of stable pediatric trauma patients.

Design/Methods: We performed a retrospective chart review of less severely injured pediatric trauma patients (age < 15 years old) at our institution, a level 1 pediatric trauma center, from January 2020 to June 2023. We reviewed all chest x-ray findings to determine how often acute traumatic injuries were present, and additionally reviewed the mechanism of injury, the presence of symptoms/signs of trauma, and if an intervention was performed based on chest x-ray findings

Results: Six hundred and fifty-three patients met inclusion criteria. Ninety-two percent of patients received a chest x-ray as part of their initial evaluation. Only 1.7% of patients had evidence of an acute traumatic injury on chest x-ray that required an intervention. A clavicle fracture was the most common traumatic injury identified, all of which were treated conservatively with a sling. One patient required a chest tube for a pneumothorax. Only one patient requiring an intervention did not have chest pain or physical signs of thoracic trauma (e.g. bruising). Chest pain (p = < 0.001, OR 6.63) and bruising (p = 0.013, OR 2.67) were associated with traumatic injury identified on chest x-ray

Conclusion(s): The rate of acute traumatic injury in less severely injured pediatric trauma patients is very low, with clavicle fracture being the most identified traumatic injury requiring intervention. Only one patient required a chest tube in the emergency department. Most identified injuries (e.g., rib fracture, small pneumothorax) did not require any intervention. Overall, chest x-ray imaging in less severely injured pediatric trauma patients rarely changes management and may not be necessary in the initial evaluation of these patients, in the absence of signs or symptoms of acute thoracic injury