P2.E093: Chest X-ray Rarely Changes the Management of Stable Pediatric Trauma Patients

Background: A chest radiograph is a standard component of a patient evaluation in the setting of a trauma team activation at our institution. However, in less severely injured (i.e., tier II) trauma patients, the utility of chest x-ray as a screening tool has not been well described in the pediatric population.

Methods: We performed a retrospective chart review of less severely injured pediatric trauma patients (age < 15 years old) at our institution, a level 1 pediatric trauma center, from January 2020 to June 2023. We reviewed all chest x-ray findings to determine how often acute traumatic injuries were present, and additionally reviewed the mechanism of injury, the presence of symptoms/signs of trauma, and if an intervention was performed based on chest x-ray findings.

Results: Four hundred and forty-one patients met inclusion criteria. Ninety one percent of patients received a chest x-ray as part of their initial evaluation. Only 1.7% of patients had evidence of an acute traumatic injury on chest x-ray that required an intervention. A clavicle fracture was the most common traumatic injury identified, all of which were treated conservatively with a sling. One patient required a chest tube for a pneumothorax. Only one patient requiring an intervention did not have chest pain or physical signs of thoracic trauma (e.g. bruising).

Conclusion: The rate of acute traumatic injury in less severely injured pediatric trauma patients is very low, with clavicle fracture being the most identified traumatic injury requiring intervention. Most other identified injuries (e.g., rib fracture, small pneumothorax) did not require any intervention. Overall, chest x-ray in less severely injured pediatric trauma patients rarely changes management and may not be necessary in the initial evaluation of these patients in the absence of symptoms/signs of acute thoracic injury.