Indication of whole body computed tomography in pediatric polytrauma patients—Diagnostic potential of the Glasgow Coma Scale, the mechanism of injury and clinical examination. Issue 105 (August 2018)

• Record Type: Journal Article
• Authors: Frellesen, Claudia; Klein, Daniel; Tischendorf, Patricia; Wichmann, Julian L.; Wutzler, Sebastian; Frank, Johannes; Ackermann, Hanns; Vogl, Thomas J.; Albrecht, Moritz H.; Eichler, Katrin
• Is Part Of: European journal of radiology. Issue 105(2018)
• Page Start: 32
• Page End: 40
• Publication Date: 2018-08
• Subjects: Pediatric polytrauma patients -- Whole body CT -- Indication -- GCS -- Mechanism of injury; Medical radiology -- Periodicals; Radiology -- Periodicals; Radiologie médicale -- Périodiques; Medical radiology; Periodicals; 616.075705
• DOI: 10.1016/j.ejrad.2018.05.022
• Languages: English
• ISSNs: 0720-048X

Abstract

Highlights: There is no clinical variable, which can be used as sole indication for WBCT in pediatric polytrauma patients. The indication to undergo WBCT in pediatric polytrauma patients should be based on the synopsis of all clinical variables. In combination without a suspicious finding in the clinical examination, major trauma is unlikely after mild trauma. Dedicated CT of individual body regions based on combinations of severity of MOI and clinical examination may be preferable. Cranial CT is recommended at GCS ≤ 13. Abstract: Objective: To evaluate the diagnostic potential of the Glasgow Coma Scale (GCS), the mechanism of injury (MOI) and clinical examination (CE) for the indication of whole body computed tomography (WBCT) in pediatric polytrauma patients. Materials & methods: 100 pediatric polytrauma patients with WBCT were analysed in terms of age, gender, (MOI), GCS, detected injury, FAST, CE and Injury Severity Score (ISS). Correlations between all clinical variables and patient groups with (p+) and without (p−) injury were assessed. Results: Mean age was 9.13 ± 4.4 years (28% female patients). Injury was detected in 71% of the patients, most commonly of the head (43%). There was no significant correlation between type or severity of MOI and ISS (p > 0.1). None of the clinical variables had a significant predictive effect on p+. The optimum discrimination threshold of GCS was at 12.5 relating to craniocerebral injuries. Severity of MOI and FAST showed best predictive effects on thoracic and abdominal pathologies, respectively, but with only low sensitivities (<20%). Conclusion: There is no clinical variable, which can be used as sole indication for WBCT in pediatric polytrauma patients. GCS had a significant predictive value for craniocerbral injuries and CCT is recommended at GCS ≤ 13.