Pediatric Blunt Research Articles

Pelvic Free Fluid in Asymptomatic Pediatric Blunt Abdominal Trauma Patients: A Case Series and Review of the Literature

BackgroundWith focused assessment with sonography in trauma (FAST) examinations being performed more commonly on pediatric trauma patients, emergency providers will encounter a positive FAST examination in patients with benign abdominal examinations. This poses a diagnostic dilemma for the provider when deciding whether to obtain a computed tomography (CT) scan of the abdomen/pelvis, observe the patient, or admit the patient. Case ReportWe report a series of pediatric patients involved in blunt abdominal trauma who had small pelvic free fluid on FAST but a benign abdominal examination. Three patients were managed without CT scan and 2 with CT scan. All patients did well and were discharged home. Why Should an Emergency Physician Be Aware of This?Free intra-abdominal fluid may be physiologic in both male and female pediatric patients. Clinical examination and hemodynamic stability should be taken into account when deciding to order a CT scan. We review the literature and highlight new protocols that may decrease CT utilization and ionizing radiation exposure, though further studies in this specific population are needed.

Management and Outcomes of Pediatric High Grade Blunt Renal Trauma

Management and Outcomes of Pediatric High Grade Blunt Renal Trauma

Which pediatric blunt trauma patients do not require pelvic imaging?

This study aimed to develop a tool in identifying traumatized children at low risk of pelvic fracture and to determine the sensitivity of this low-risk model for pelvic fractures. We hypothesized that the proportion of children without predictors with pelvic fracture is less than 1%. This is a retrospective trauma registry analysis of previously healthy children 1 year to 17 years old presenting to the pediatric emergency department with blunt trauma. Postulated predictors of pelvic fracture on radiograph or computed tomography included pain/abnormal examination result of the pelvis/hip, femur deformity, hematuria, abdominal pain/tenderness, Glasgow Coma Scale (GCS) score of 13 or lower, and hemodynamic instability. We used multivariable logistic regression to identify independent predictors of fracture. Of 1,121 eligible patients (mean [SD] age, 8.5 [4.6] years), 87 (7.8%) had pelvic fracture. Independent predictors included pain/abnormal examination result of the pelvis/hip (odds ratio [OR], 16.7; 95% confidence interval [CI], 9.6-29.1), hematuria (OR, 6.6; 95% CI, 3.0-14.6), femoral deformity (OR, 5.9; 95% CI, 3.1-11.3), GCS score of 13 or lower (OR, 2.4; 95% CI, 1.3-4.3), and hemodynamic instability (OR, 3.4; 95% CI, 1.7-6.9). One of 590 children (0.2%; 95% CI, 0-0.5%) without predictors had pelvic fractures versus 86 (16.2%) of 531 in those with one or more predictors (OR, 119; 95% CI, 16.6-833). One of 87 children with pelvic fractures had no predictors (1.1%; 95% CI, 0-3%). When assuming a 100% radiography rate, this tool saves 53% pelvic radiographs. Children with multiple blunt trauma without pain/abnormal examination result of the pelvis/hip, femur deformity, hematuria, abdominal pain/tenderness, GCS score of 13 or lower, or hemodynamic instability constitute a low-risk population for pelvic fracture, with less than 0.5% risk rate. This population does not require routine pelvic imaging. Therapeutic study, level IV.

Resource use in pediatric blunt and penetrating trauma

BackgroundTrauma is one of the leading causes of pediatric morbidity and mortality with significant patient and economic impacts that necessitate constant study. Significant differences in outcomes and resource use exist between blunt and penetrating mechanisms. MethodsThe National Trauma Data Bank was analyzed for patients aged 0–18 y with International Classification of Diseases, 9th Revision injury codes for blunt and penetrating trauma from 2007–2012. Demographic information, causes, treatments, complications, and outcomes were assessed. ResultsA total of 748,347 pediatric trauma patients were assessed. Blunt trauma was identified as the cause in 601,898 (80.43%) patients compared with 55,597 (7.4%) patients with penetrating trauma. Blunt trauma patients were younger on average and more likely to be female. Despite having a slightly higher mean injury severity scores, blunt trauma patients had shorter length of stay in the hospital (2.9 versus 4.3 d, P < 0.001), fewer complications (34.8% versus 38.6%, P < 0.001), and a much lower mortality rate (1.3% versus 7.1%, P < 0.001). Blunt trauma patients were more likely to undergo computed tomography scanning but less likely to receive transfusions (1.79% versus 5.5%, P < 0.001) and to undergo exploratory laparotomy (0.9% versus 9.4%, P < 0.001) and thoracotomy (0.07% versus 1.7%, P < 0.001). Variations in outcome and resource use were also noted by age. ConclusionsCompared with penetrating trauma, blunt trauma is more common and patients have shorter length of stay, less complications, lower mortality, and are less likely to need operative intervention or blood transfusion. Resource use also varied by age.

Maintaining Low Transfusion and Angioembolization Rates in the Age of Nonoperative Management of Pediatric Blunt Splenic Injury

Nonoperative management of hemodynamically stable blunt splenic injury (BSI) is the gold standard in children. Recent studies from nonpediatric surgery-specialized trauma centers have demonstrated a rise in transfusion and angioembolization associated with decreased splenectomy rates. We investigate the rate of splenectomy and nonsurgical interventions (angioembolization, blood transfusion) for BSI in a pediatric surgery-specialized trauma center. We conducted a retrospective review of children (0 to 18 years) treated between September 2001 and September 2011 at a children's hospital. Analyzed data included presenting vital signs, nadir hemoglobin, splenic injury grade, Revised Trauma Score, and Injury Severity Score (ISS). Measured outcomes included transfusion, angioembolization, and splenectomy rates. The study period was divided into three time periods to identify possible trends and compared with national averages. There were 180 patients, 91 with multiple injuries (50.6%) and 89 (49.4%) with isolated BSI. Seventy-six per cent of patients were male, average age was 12.8 years, and average ISS was 14.7. The overall splenectomy rate was 1.7 per cent (1.1% for isolated splenic injury). Our angioembolization rate was 0.6 per cent compared with 7.4 to 16 per cent nationally. Our transfusion rate was 14.4 per cent overall and 5.6 per cent for isolated splenic injury compared with 9.5 to 24.9 per cent nationally. Intervention rates remained unchanged over the study period. Splenectomy rates have remained low at our institution without an increase in angioembolization or transfusion. Children with splenic injuries treated at dedicated pediatric hospitals can be successfully managed nonoperatively without angioembolization or blood transfusion.

Emergency Airway Management for Pediatric Blunt Neck Trauma

Pediatric laryngotracheal injuries as a result of blunt neck trauma are exceedingly rare, but they have the potential for fatal consequences if not identified and managed appropriately. Two cases on the spectrum of laryngotracheal trauma are presented followed by an overview of pediatric laryngotracheal trauma with a focus on acute airway management. Special considerations must be taken into account when evaluating and treating children with laryngotracheal injuries. Standard orotracheal intubation by direct laryngoscopy is risky, and awake tracheostomy is often not feasible. Flexible or rigid bronchoscopic airway management is the preferred method of tracheal intubation prior to tracheostomy. The airway surgeon must be prepared to perform an efficient, emergency tracheostomy. In stable patients, flexible fiberoptic laryngoscopy is an important diagnostic tool in the evaluation of laryngotracheal injuries. After ensuring a secure airway, further goals of management are aimed at preserving normal laryngeal function: airway patency, voice, and swallowing.

Computed tomography is not justified in every pediatric blunt trauma patient with a suspicious mechanism of injury

ObjectiveComputed 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. MethodsForty-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. ResultsThirty-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. ConclusionThe routine use of CT in asymptomatic pediatric patients with a suspicious mechanism of blunt trauma injury is not justified.

Mechanism of injury alone is not justified as the sole indication for computed tomographic imaging in blunt pediatric trauma

The liberal use of computed tomographic (CT) scanning during the evaluation of injured children has increased their exposure to the risks of ionizing radiation. We hypothesized that CT imaging performed for mechanism of injury alone is unnecessary and that serious or life-threatening injury is rarely identified. All pediatric blunt trauma team evaluations (age < 15 years) at a pediatric Level 2 trauma center over 72 months were reviewed. CT findings in patients with normal Glasgow Coma Scale (GCS) score, vital signs (VS), and physical examination (PE) (Group I) were compared with Group II (GCS score < 15), Group III (abnormal VS/PE), and Group IV (abnormal GCS score, VS/PE). Variables associated with any positive finding were entered into a multiple logistic regression model to assess for independent contributions. Each patient's total effective radiation dose from CT scans in millisieverts was calculated using an age-adjusted scale. A total 174 children met trauma team activation criteria (mean [SD] age, 7 [5] years; 63% male; mean [SD] Injury Severity Score [ISS], 10 [10]). A total of 153 (88%) were imaged by CT (I, 54 of 66; II, 25 of 25; III, 49 of 57; IV, 25 of 26). No patient in Group I had a serious finding on CT compared with Group II (17 of 77), III (25 of 111), and IV (18 of 72). Mortality was 4%. Radiation dose (mSv) from CT was not different among the groups (I, 17 [14]; II, 29 [13]; III, 21 [16]; IV, 27 [17]). By univariate analysis, GCS score of less than 15 (p < 0.01) and respiratory rate of greater than 30 (p = 0.09) were associated with a positive CT finding. By logistic regression analysis, GCS score of less than 15 remained the only variable associated significantly with a positive finding (odds ratio, 6.7; 95% confidence interval, 3-14; p < 0.01). In children imaged based only on mechanism, no patient had a serious positive finding but was subjected to radiation doses associated with an increased risk of future malignancy. The use of CT imaging in injured children in the absence of a physiologic or anatomic abnormality does not seem to be justified. Care management study, level IV.

Which Pediatric Blunt Trauma Patients do not Require Pelvic Radiographs?

Which Pediatric Blunt Trauma Patients do not Require Pelvic Radiographs?

Evaluation of Radiation Exposure to Pediatric Trauma Patients

BackgroundPediatric trauma patients pose a diagnostic challenge to physicians. Computed tomography (CT) imaging identifies life-threatening injuries quickly and efficiently. CT radiation dose in pediatric trauma patients is a concern. Study ObjectivesWe evaluated the cumulative effective dose of radiation received by pediatric blunt trauma patients and assessed characteristics of patients and studies received. MethodsWe retrospectively identified pediatric blunt trauma patients at a Level I trauma center between January 1 and December 31, 2006 utilizing the North Carolina Trauma Registry. We searched the patient radiographic history for images in the 7 days after their trauma event. We calculated cumulative effective radiation dose using dose length product and age coefficients. We collected demographic information including age, sex, mechanism of injury, hospital length of stay, and discharge status. ResultsSeventy-five pediatric blunt trauma patients with available radiographic records were included. The median age was 11.7 years; males comprised 64% of patients; median Injury Severity Score was 13.8; 64% were transfer patients; median number of CT scans during initial evaluation was 3.4 for directly seen patients and two for transferred patients. Mean effective ionizing radiation dose was 11.4 mSv for CT scans performed in the first 24 h. Sixteen percent of admitted patients had CT scans in the subsequent 6 days, with an average additional CT dose of 4 mSv. Average number of plain radiographs was five. ConclusionsPediatric blunt trauma patients receive a major radiation burden in their initial evaluation. Patients who are transferred from an outside facility endure an even higher dose of radiation.

Are routine pelvic radiographs in major pediatric blunt trauma necessary?

Screening pelvic radiographs to rule out pelvic fractures are routinely used for the initial evaluation of pediatric blunt trauma. Recently, the utility of routine pelvic radiographs in certain subsets of patients with blunt trauma has been questioned. There is a growing amount of evidence that shows the clinical exam is reliable enough to obviate the need for routine screening pelvic radiographs in children. To identify variables that help predict the presence or absence of pelvic fractures in pediatric blunt trauma. We conducted a retrospective study from January 2005 to January 2010 using the trauma registry at a level 1 pediatric trauma center. We analyzed all level 1 and level 2 trauma victims, evaluating history, exam and mechanism of injury for association with the presence or absence of a pelvic fracture. Of 553 level 1 and 2 trauma patients who presented during the study period, 504 were included in the study. Most of these children, 486/504 (96.4%), showed no evidence of a pelvic fracture while 18/504 (3.6%) had a pelvic fracture. No factors were found to be predictive of a pelvic fracture. However, we developed a pelvic fracture screening tool that accurately rules out the presence of a pelvic fracture P = 0.008, NPV 99, sensitivity 96, 8.98 (1.52-52.8). This screening tool combines eight high-risk clinical findings (pelvic tenderness, laceration, ecchymosis, abrasion, GCS <14, positive urinalysis, abdominal pain/tenderness, femur fracture) and five high-risk mechanisms of injury (unrestrained motor vehicle collision [MVC], MVC with ejection, MVC rollover, auto vs. pedestrian, auto vs. bicycle). Pelvic fractures in pediatric major blunt trauma can reliably be ruled out by using our pelvic trauma screening tool. Although no findings accurately identified the presence of a pelvic fracture, the screening tool accurately identified the absence of a fracture, suggesting that pelvic radiographs are not warranted in this subset of patients.

Bloody Urine after Minor Trauma in a Child: Isolated Renal Injury versus Congenital Anomaly?

Bloody Urine after Minor Trauma in a Child: Isolated Renal Injury versus Congenital Anomaly?

Pediatric laryngeal trauma: A case series at a tertiary children's hospital

Background Pediatric blunt or sharp laryngotracheal injuries are infrequent because of the softer cartilages and the protection of the prominent mandible. These injuries usually occur secondary to striking furniture or via the “clothesline” injury. Methods We present five cases of pediatric laryngotracheal injury (thyroid cartilage, true vocal cords, cricoid cartilage, cricotracheal junction, and posterior tracheal wall). Results We examined the need for intubation, need for tracheostomy, length of intubation, length of hospital stay, interval until direct laryngoscopy, use of steroids, post-injury swallowing, and post-injury phonation. Discussion Three of the five patients were intubated either prior to arrival or upon arrival to the emergency department. Two of the patients underwent direct laryngoscopy on the day of arrival. Three patients received steroids. CT (computed tomography) was not helpful in diagnosis or decision regarding treatment. The patients with thyroid cartilage fracture, cricoid cartilage fracture, cricotracheal separation, and posterior tracheal wall tear required open repair. The tracheal wall injury, cricoid fracture, and cricotracheal separation were repaired with sutures and the thyroid cartilage fracture with a plate and screws. One tracheal stent was placed. Two open repairs were performed within 24 h of injury. The patient with posterior tracheal wall injury experienced persistent dysphagia and dysphonia, which may have been secondary to intraoperative dissection. Conclusion Dyspnea was not necessarily indicative of the severity of injury in our patients. CT added little information about the integrity of the larynx not already known by physical examination. Open repair was usually indicated for the blunt neck injuries in our series. Oral intubation proved less difficult than tracheostomy in our patient with cricoid cartilage fracture.

Paediatric Blunt Laryngeal Trauma: A Review

Paediatric blunt laryngeal trauma is infrequently encountered; however, it can have fatal consequences if managed inappropriately. This paper provides an overview of the relatively limited literature available on the subject and highlights current controversies and recent advances in the management of these injuries.

Comparison of Hybrid III Child Test Dummies to Pediatric PMHS in Blunt Thoracic Impact Response

The limited availability of pediatric biomechanical impact response data presents a significant challenge to the development of child dummies. In the absence of these data, the development of the current generation of child dummies has been driven by scaling of the biomechanical response requirements of the existing adult test dummies. Recently published pediatric blunt thoracic impact response data provide a unique opportunity to evaluate the efficacy of these scaling methodologies. However, the published data include several processing anomalies and nonphysical features. These features are corrected by minimizing instrumentation and processing error to improve the fidelity of the individual force-deflection responses. Using these data, biomechanical impact response corridors are calculated for a 3-year-old child and a 6-year-old child. These calculated corridors differ from both the originally published postmortem human subject (PMHS) corridors and the impact response requirements of the current child dummies. Furthermore, the response of the Hybrid III 3-year-old test dummy in the same impact condition shows a similar deflection but a significantly higher force than the 3-year-old corridor. The response of the Hybrid III 6-year-old dummy, on the other hand, correlates well with the calculated 6-year-old corridor. The newly developed 3-year-old and 6-year-old blunt thoracic impact response corridors can be used to define data-driven impact response requirements as an alternative to scaling-driven requirements.

43 A SUCCESSFUL PROSPECTIVE TRAIL OF CONSERVATIVE MANAGEMENT FOR PEDIATRIC BLUNT RENAL TRAUMA

You have accessJournal of UrologyTrauma/Reconstruction: Trauma & Reconstructive Surgery I1 Apr 201043 A SUCCESSFUL PROSPECTIVE TRAIL OF CONSERVATIVE MANAGEMENT FOR PEDIATRIC BLUNT RENAL TRAUMA Carrie Fitzgerald, Peter Tran, Jeff Burnell, and Richard Santucci Carrie FitzgeraldCarrie Fitzgerald More articles by this author , Peter TranPeter Tran More articles by this author , Jeff BurnellJeff Burnell More articles by this author , and Richard SantucciRichard Santucci More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2010.02.088AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Expectant management of hemodynamically stable blunt renal trauma is standard of care in adults. Conservative management of blunt renal trauma is also safe in properly selected pediatric patients. This study prospectively evaluated the safety and efficacy of an ultra conservative blunt renal trauma protocol at a Level 1 pediatric trauma center. METHODS Thirty-nine pediatric patients with blunt renal trauma were identified from 2003 to 2008. An ultra conservative approach was implemented in these consecutively presenting patients. Applied standards were as follows; imaging reserved for patients with gross hematuria, microscopic hematuria with concomitant shock or significant deceleration injury. Non-operative management if hemodynamically stable, responds favorably to < 2 units blood transfusions and imaging doesn't show lesion requiring operating (ureteral injury, Grade V vascular injury). Exploratory laparotomy for non-renal causes did not necessarily warrant renal exploration. Outcomes evaluated were injury grade, hematuria, operative management, length of stay and associated injuries. Study design was based on a successful, published retrospective review of blunt renal management from 1990 to 2002, at the same institution. RESULTS The 39 confirmed cases were assigned American Association for the Surgery of Trauma (AAST) renal injury, grade I (N=13), grade II (N=8), grade III (N=11), grade IV (N=6), grade V (N=1). Ultra conservative management resulted in a 100% renal salvage rate, 38 of 39 (97%) managed non-operatively and 1 of 39 (3%) requiring a delayed renorrhaphy. Prospective findings were comparable to results in retrospective review from 1990-2002. Combining datasets, 1990-2008 (N=100), a 99% renal salvage rate was seen. Mean length of stay (LOS) did not correlate with injury grade. LOS >10 days (N=7, mean 20 days) correlated only with the degree of non-renal injuries (100%), ventilator dependent respiratory failure (57%) and/or non-renal surgical intervention (43%). Salvage rates may reflect limited number of grade 5 blunt renal trauma cases 2003-2008 (N=1), 1990-2002 (N=2). CONCLUSIONS This is the first prospective study of a non-operative protocol for management of blunt pediatric renal trauma, which had been previously seen to be safe in a retrospective study at this same institution. Expectant management of non-exsanguinating pediatric blunt renal trauma is safe and effective. Also, serious renal injuries were not missed by applying adult diagnostic imaging protocols to children. Detroit, MI© 2010 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 183Issue 4SApril 2010Page: e18 Advertisement Copyright & Permissions© 2010 by American Urological Association Education and Research, Inc.MetricsAuthor Information Carrie Fitzgerald More articles by this author Peter Tran More articles by this author Jeff Burnell More articles by this author Richard Santucci More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Angiographic Embolization Is Safe and Effective Therapy for Blunt Abdominal Solid Organ Injury in Children

: Angiographic embolization (AE) is used to control hemorrhage in adult blunt liver, spleen, and kidney (ASO) injuries. Pediatric experience with AE for blunt ASO injuries is limited. We reviewed our use of AE to control bleeding pediatric blunt ASO injuries for efficacy and safety. : A 5-year review (trauma registry and charts) of children (age < or = 16 years) who had AE for hemorrhage from blunt ASO injuries. Nonoperative management was attempted in all stable children with blunt ASO injuries. Children with ongoing hemorrhage underwent AE. The success of AE and complications were evaluated. Data were reviewed on injury type and grade, injury severity score, length of intensive care unit stay (LOS-ICU) and length of hospital stay (LOS), and complications. : One hundred twenty-seven patients with 149 blunt ASO injuries were identified (72 spleen, 51 liver, and 26 renal). Two children had immediate splenectomies. Seven children underwent AE: two spleen (grades IV and V), two liver (grades III and IV), and three grade IV renal injuries. Three children received blood before embolization. Mean age and injury severity score were 12.3 years +/- 3.7 years and 22.4 +/- 10.0,respecyively. Mean intensive care unit stay was 4.8 days +/- 5.5 days with a mean length of hospital stay of 12.8 days +/- 5.5 days. Embolization was successful in all children; there were no procedure-related complications. Four minor complications occurred; two pleural effusions and two patients with transient hypertension. A nephroblastoma was later found in one renal injury requiring nephrectomy. : AE is a safe and an effective technique for controlling hemorrhage from blunt ASO injuries in select pediatric patients.

Utility of Computed Tomography Scan in Pediatric Blunt Chest Trauma

Meyer, Philippe G. MD; Blanot, Stéphane MD; Daban, Jean Louis MD; Orliaguet, Gilles A. MD, PhD Author Information

A Reliable Screening Test to Predict Liver Injury in Pediatric Blunt Torso Trauma

We determined the validity of serumaspartate aminotransferase (AST) and alanine aminotransferase(ALT) as screening tests in the identificationof liver injuries in pediatric torso trauma patients. We conducted a retrospective study inpediatric patients < 17 years of age who sustainedblunt trauma and were admitted to an urban traumacenter during a 39-month period. The serum AST andALT levels, injury severity scores (ISS), lengths of hospitaland intensive care unit stays, laparotomy andvascular embolization requirement, mortality rate, andconcomitant injuries were compared betweenpatients with and without liver injury. Of the 40 patients reviewed, 16 patients hadliver injuries. The mean serum AST and ALT levels weremarkedly higher in the liver injury (LI) group than inthe non-liver injury (NLI) group (773.4 IU/l ± 781.3 [SD]and 613.6 IU/l ± 640.0 [SD], respectively, and (67.2IU/l ± 63.2 [SD] and 55.5 IU/l ± 62.6 [SD], respectively;p < 0.01). One of the 16 LI patients and 20 of the 24 NLIpatients had AST levels < 200 IU/l or ALT levels < 125IU/l. The sensitivity, specificity, and positive and negativepredictive values were 94, 83, 79, and 95%,respectively. A serum AST > 200 IU/l or an ALT> 125 IU/l are strong predictors of liver injury in childrensustaining blunt torso trauma. We recommend theroutine use of serum transaminase levels as screeningtests in hemodynamically stable patients.

The Utility of Computed Tomography as a Screening Tool for the Evaluation of Pediatric Blunt Chest Trauma

There is a growing concern that computed tomography (CT) is being unnecessarily overused for the evaluation of pediatric patients. The purpose of this study was to analyze the trends and utility of chest CT use compared with chest X-ray (CXR) for the evaluation of children with blunt chest trauma. A 4-year retrospective review was performed for pediatric patients who underwent chest CT within 24 hours of sustaining blunt trauma at a Level-I trauma center. Trends in the use of CT and CXR were documented, and results of radiology reports were analyzed and compared with clinical outcomes. Three hundred thirty-three children, mean age 11 years, had chest CTs, increasing from 5.5% in 2001-2002 to 10.5% in 2004-2005 (p < 0.001). Conversely, in those children who underwent chest CT, the rate of initial CXR use decreased from 84% to 56% during the same period (p < 0.001). Twenty percent of chest CTs had significant positive findings. Six patients underwent emergency surgery for cardiac or arterial injuries, and all demonstrated abnormal findings on CXR or CT scout imaging. When compared with the CT, only 5% of initial CXRs falsely reported normal findings that may have altered management. CT use in children has increased rapidly for the initial evaluation of chest trauma, whereas CXR use has decreased. Despite this trend, CXR remains an acceptable screening tool to analyze which patients may require CT evaluation. A multidisciplinary approach is warranted to develop guidelines that standardize the use of CT and thereby decreases unnecessary radiation exposure to pediatric patients.