Using a whole-body computed tomography (WBCT) or “pan-scan” CT imaging approach among children with blunt trauma offers no mortality benefit over using a selective CT approach, a study published online April 9 in JAMA Pediatrics suggests.
“This outcome was consistent regardless of how severely injured the children were,” write James A. Meltzer, MD, from the Albert Einstein College of Medicine, Bronx, New York, and colleagues. “These results have implications for how emergency and trauma specialists care for injured children.”
Several studies have shown that WBCT is associated with decreased mortality among adults with blunt trauma, leading to its use as the standard imaging tool for these patients at many centers.
Although pediatric-specific data are lacking in this area, many physicians extrapolate the findings from adults to children with blunt trauma. Nevertheless, it remains unclear whether using WBCT also offers a mortality benefit in these pediatric patients.
To help address this knowledge gap, Meltzer and colleagues conducted a retrospective, multicenter cohort study, using records from the National Trauma Data Bank.
Their study included 42,912 children aged 6 months to 14 years with blunt trauma who received a CT scan within the first 2 hours after emergency department arrival.
According to the authors, 8757 (20.4%) of the 42,912 children underwent WBCT, and 405 (0.9%) children died within 7 days from emergency department arrival.
However, when the investigators used propensity score weighting to adjust for potential confounding, they found no significant difference in mortality between children with blunt trauma who underwent WBCT and those who underwent a selective CT approach (absolute risk difference, −0.2%; 95% confidence interval, −0.6% to 0.1%).
Although Meltzer and colleagues also performed subgroup analyses of children with the highest mortality risk, after adjustment, they similarly found that WBCT offered no survival benefit among children who were struck by a motor vehicle, were occupants in a motor vehicle crash, had a Glasgow Coma Scale score lower than 9, were hypotensive, or were admitted to the intensive care unit.
Nevertheless, the authors acknowledge the limitations of their study. Noting that it predominantly investigated the outcome of mortality, they suggest that WBCT may benefit the care of injured children in other ways, such as by identifying nonlethal occult injuries.
The patients included in the study also may have been more severely injured than most children with blunt trauma who present to an emergency department, they say. This is because the National Trauma Data Bank includes only patients who were admitted or died after arrival.
In addition, although they included as many potential confounders as possible in their propensity score model, the authors recognize that residual confounding may still have affected the outcome.
However, the results of this study raise questions about the routine, indiscriminate use of WBCT for children with blunt trauma, Meltzer and colleagues say.
“Although WBCT may provide more information about the injured child, that information does not appear to be lifesaving. With growing concerns regarding excessive radiation exposure for injured children, physicians should attempt to limit CT exposure whenever possible,” they conclude.
This study was supported by an Einstein-Montefiore Clinical and Translational Science Award from the National Institutes of Health/National Center for Advancing Translational Science. The authors have disclosed no relevant financial relationships.
JAMA Pediatrics. Published online April 9, 2018. Abstract
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