Emergency Department Imaging of Pediatric Patients with Blunt Thoracic Trauma: A Systematic Review, Meta-Analysis, and Practice Management Guideline

Pediatric blunt torso trauma is a common reason for emergency department visits. Computed tomography (CT) is a highly sensitive tool for diagnosis of thoracic cavity injuries. However, the prevalence of thoracic injuries requiring intervention is lower in children compared with adults, and ionizing radiation from CT is associated with higher potential harms in this population. The role of screening chest x-ray and point-of-care ultrasound in identifying thoracic injuries requiring operative and procedural intervention has not been systematically reviewed previously. Four relevant questions related to imaging after blunt thoracic trauma in pediatric patients were developed using clearly defined Population (P), Intervention (I), Comparison (C), and appropriately selected Outcomes (O) (PICO). A systematic review and meta-analysis were conducted using the Grading of Recommendations Assessment, Development and Evaluation methodology. The multispecialty working group reached consensus on the final evidence-based recommendation. A total of 10,447 articles were screened, and data from 3 studies were included in the final meta-analysis. All the studies were retrospective in design, and the quality of the available evidence was determined to be very low. Based on the limited data, we were only able to make a recommendation on one of the 4 drafted PICO questions. In pediatric (<18 years) patients with blunt trauma presenting to the emergency department who have no or minor traumatic findings on initial screening chest imaging, we conditionally recommend that chest CT not be routinely used to identify thoracic injuries requiring procedural or operative intervention, or to identify thoracic injuries leading to mortality.