CT Better than X-Ray for Most Children with Blunt Torso Trauma

For most children who present with blunt torso trauma, plain anteroposterior pelvic radiographs may be unnecessary when a CT is planned, according to an article published in the Annals of Emergency Medicine.

Researchers from several facilities in the U.S. sought to evaluate the sensitivity of plain anteroposterior pelvic radiographs when assessing the status of children who have sustained blunt pelvic trauma and have pelvic fractures or dislocations. 

“Abdominal/pelvic CT is a superior diagnostic test compared to plain anteroposterior pelvic X-rays for diagnosing children with pelvic fractures or dislocations,” lead study author Maria Kwok, MD, of the Columbia University Medical Center in New York, NY said. “Because of concerns about lifetime exposure to radiation in children, appropriate use of radiography is important.”

The researchers conducted a prospective multicenter observational study of children (under 18 years) who presented to the Pediatric Emergency Care Applied Research Network following blunt torso trauma.

A total of 12,044 children (under 18 years, mean age 11.1) were enrolled in the study. A total of 7,808 (65 percent) patients underwent pelvic radiologic studies to screen for pelvic fractures or dislocations.

Of the 7,808 patients who underwent studies, 5,076 (65 percent) underwent plain anteroposterior pelvic radiographs and 2,772 (55 percent) of those children also had abdominal or pelvic CT. The remainder of the 7,808 patients underwent pelvic CT or magnetic resonance imaging (MRI) alone.

The results showed that 451 children (3.7 percent) were diagnosed with pelvic fractures or dislocations. Plain pelvic radiographs showed a sensitivity of 78 percent for identifying patients with pelvic fractures or dislocations. Of the patients not correctly identified as having pelvic fractures or dislocations, 98 percent were correctly diagnosed by abdominal/pelvic CT scanning.

“Abdominal or pelvic CT is a superior diagnostic test compared with plain anteroposterior pelvic radiographs for diagnosing children with pelvic fractures or dislocations,” the authors wrote. “Physicians may use this information when determining the need for pelvic radiography.”

The researchers concluded that use of plain pelvic radiographs had limited sensitivity for identifying children with pelvic fractures or dislocations after blunt trauma, including patients undergoing operative intervention and those with hypotension.