Role of clinical suspicion in pediatric blunt trauma patients with severe mechanisms of injury

Objectives

In adult patients with blunt trauma, severe mechanism of injury leads to routine pan-computed tomography (CT). Due to concerns about the risk of radiation, we sought to determine whether clinical suspicion could identify children requiring radiographic imaging.

Methods

A prospective study was conducted in a pediatric emergency department of a Level 1 trauma center. Patients ≤ 14 years presenting with blunt trauma due to predefined severe mechanisms were eligible. Physicians recorded their suspicions for clinically significant injury (CSI). Imaging was obtained at the physician's discretion. CSI was defined as injury requiring intervention or hospital admission ≥ 24 h. Both admitted and discharged patients were contacted ≥ 2 weeks after presentation to document undetected injuries.

Results

837 patients were eligible; 753 were enrolled. 159 patients were excluded because the mechanism did not meet severity criteria. Follow-up was completed for 529/594 remaining patients. Physicians were suspicious of all injuries in 71/75 patients with CSI and had no suspicions in 382/454 without CSI. The 75 injured patients had 153 CSIs; positive suspicion of CSI was recorded for 149 injuries. The four patients who sustained unsuspected injuries had multiple other suspected injuries. Of the 594 patients, 42 received focused CT and 14 underwent pan-CT. No patient had previously undetected injuries on follow-up.

Conclusion

In our study, clinical suspicion was able to identify children with CSI. If further studies support our findings, using clinical suspicion rather than mechanism alone to guide radiographic imaging may avoid unnecessary radiation exposure.