Chest x-ray vs. computed tomography of the chest in pediatric blunt trauma

Introduction: Chest x-ray (CXR) has been shown to be an effective detection tool for clinically significant trauma. We evaluated differences in findings between CXR and computed tomography of the chest (CCT), their impact on clinical management and the performance of the CXR. Methods: This retrospective study examined children (less than 18 years) who received a CXR and CCT between 2009 and 2015. We compared characteristics of children by conducting univariate analysis, reporting the proportion of additional diagnoses captured by CCT, and using it to evaluate the sensitivity and specificity of the CXR. Outcome variables were diagnoses made by CCT as well as the ensuing changes in the clinical management attributable to the diagnoses reported by the CCT and not observed by the CXR. Results: In 1235 children, CCT was associated with diagnosing higher proportions of contusion or atelectasis (60% vs 31%; p <.0001), pneumothorax (23% vs 9%; p <.0001), rib fracture (18% vs 7%; p <.0001), other fracture (20% vs 10%; p <.0001), diaphragm rupture (0.2% vs 0.1%; p =.002), and incidental findings (7% vs 2%; p <.0001) as compared to CXR. CCT findings changed the management of 107 children (8.7%) with 32 (2.6%) of the changes being surgical procedures. The overall sensitivity and specificity of the CXR were 57.9% (95% CI: 54.5–61.2) and 90.2% (95% CI: 86.8–93.1), respectively. The positive predictive value and negative predictive value were 93.1% and 48.6%, respectively. Conclusion: CXR is a useful initial screening tool to evaluate pediatric trauma patients along with clinical presentation in the Emergency Department in children. Level of evidence: Level III, diagnostic test.