Key Points
■ Normal CT of head, chest, abdomen, and pelvis effectively excludes need for emergent or urgent “surgical” intervention (limited to moderate evidence).
■ Emergent MR is usually reserved for patients with evolving or unexplained neurological deficits (moderate evidence).
■ The diagnostic imaging test of choice for blunt trauma to the abdomen and pelvis is CT (moderate evidence). Sonography should be reserved for subjects too hemodynamically unstable to tolerate CT.
■ The chest radiograph is an excellent screening test for mediastinal vascular injury that may require CT angiography or urgent surgery (limited to moderate evidence).
■ CT represents a significant radiation burden to young patients. All practitioners should adhere to ALARA (as low as reasonably achievable) principles in minimizing radiation dose to patients. However, when appropriately indicated, CT should be performed because short-term benefits in the acute trauma setting far outweigh long-term risk of radiation.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
References
Feliciano DV, Moore EE eds. Trauma, 6th ed. New York: McGraw-Hill Companies: 2008; 1430.
Alterman DM. Considerations in Pediatric Trauma. e-Medicine: Pregnancy and Pediatric Trauma Management 2008 8/19/08 [cited 2008 9/25/08]; Available from: http://www.emedicine.com/med/TOPIC3223.HTM.
Ciftci AO et al. J Pediatr Surg 1997; 32(12):1732–1734.
Gerstenbluth RE, Spirnak JP, Elder JS. J Urol; 2002; 168(6):2575–2578.
Nance ML, Keller MS, Stafford PW. J Pediatr Surg 2000; 35(9):1300–1303.
Arias, I. Preventing Childhood Injuries 2008 5/1/08 [cited 2008 9/25]; Available from: http://www.hhs.gov/asl/tesepsy/2008/05/t20080501d.html.
Davis DH et al. Pediatrics 2005; 115(1):89–94.
Flood RG, Mooney DP. J Trauma 2006; 61(2):340–345.
Holmes JH et al. J Trauma 2005; 59(6):1309–1313.
Potoka DA et al. J Trauma 2000; 49(2):237–245.
Sherman HF Landry VL, Jones LM. J Trauma 2001; 50(5):784–791.
Tataria M et al. J Trauma 2007; 63(3):608–614.
Cloutier DR et al. J Pediatr Surg 2004; 39(6):969–971.
Galvan DA, Peitzman AB. Curr Opin Crit Care 2006; 12(6):590–594.
Nwomeh BC et al. J Trauma 2004; 56(3):537–541.
Saladino R, Lund D, Fleisher G. Ann Emerg Med 1991; 20(6):636–640.
Henderson CG et al. J Urol 2007; 178(1):246–250; discussion 250.
Ohtsuka Y et al. Pediatr Surg Int 2003; 19(1–2):29–34.
Rogers CG et al. Urology 2004; 64(3):574–579.
Russell RS et al. J Urol 2001; 166(3):1049–1050.
Bensard DD et al. J Trauma 1996; 41(3):476–483.
Campbell DJ et al. Am Surg 2003; 69(12):1095–1099.
Canty TG, Sr, Canty TG Jr et al. Trauma 1999; 46(2):234–240.
Desai KM et al. J Trauma 2003; 54(4):640–645; discussion 645–646.
Jones VS et al. J Pediatr Surg 2007; 42(8):1386–1388.
Mirvis SE, Gens DR, Shanmuganathan K. Am J Roentgenol 1992; 159(6):1217–1221.
Santschi M et al. Can J Surg 2005; 48(5):373–376.
Winthrop AL, Wesson DE, Filler RM. J Pediatr Surg 1986; 21(9):757–760.
Mattix KD et al. J Pediatr Surg 2007; 42(2):340–344.
Meier DE. et al. J Pediatr Surg 2001; 36(2):341–344.
Roche BG, Bugmann P, Le Coultre C. Eur J Pediatr Surg 1992; 2(3):154–156.
Takishima T et al. J Pediatr Surg 1996; 31(7):896–900.
Tso EL, Beaver BL, Haller JA, Jr J Pediatr Surg 1993; 28(7):915–919.
Arkovitz MS, Johnson N, Garcia VF . J Trauma 1997; 42(1):49–53.
Deluca JA et al. Am Surg 2007; 73(1):37–41.
Firstenberg MS et al. J Pediatr Surg 1999; 34(7):1142–1147.
Jobst MA, Canty TG, Sr., Lynch FP J Pediatr Surg 1999; 34(5):818–823; discussion 823–824.
Bruckner BA et al. Ann Thorac Surg 2006; 81(4):1339–1346.
Pillai SB et al. J Trauma 2000; 48(6):1048–1050; discussion 1050–1051.
Richards JR, Derlet RW. Injury 1997; 28(3):181–185.
Chakravarthy B et al. Pediatr Emerg Care 2007; 23(10):738–744.
DiMaggio C, Durkin M. Acad Emerg Med 2002; 9(1):54–62.
Ivarsson BJ, Crandall JR, Okamoto M, Traffic Inj Prev 2006; 7(3):290–298.
Orsborn R et al. Air Med J 1999; 18(3):107–110.
Peng RY, Bongard FS. J Am Coll Surg 1999; 189(4):343–348.
Sala D et al. J Pediatr Surg 2000; 35(10):1478–1481.
Spiguel L et al. Am Surg 2006; 72(6):481–484.
Yamamoto LG, Wiebe RA, Matthews WJ, Jr Pediatr Emerg Care 1991; 7(5):267–274.
Britton JW. WMJ 2005; 104(1):33–36.
Demetriades D et al. J Trauma 2005; 58(2):342–345.
Durkin M.S et al. Neurosurgery 1998; 42(2):300–310.
Hall JR et al. J Trauma 1989; 29(9):1273–1275.
Lallier M et al. J Pediatr Surg 1999; 34(7):1060–1063.
Murray JA et al. Am Surg 2000; 66(9):863–865.
Peclet MH et al. J Pediatr Surg 1990; 25(1):85–90; discussion 90–91.
Scheidler MG et al. J Pediatr Surg 2000; 35(9):1317–1319.
Wang MY. et al. J Pediatr Surg 2001; 36(10):1528–1534.
Ashbaugh SJ, Macknin ML, VanderBrug Medendorp S. Clin Pediatr (Phila) 1995; 34(5):256–260.
Brown RL et al. J Pediatr Surg 2002; 37(3):375–380.
Cushman R et al. CMAJ 1990; 143(2):108–112.
Powell EC, Tanz RR. Arch Pediatr Adolesc Med 2000; 154(11):1096–1100.
Powell EC, Tanz RR, DiScala C. Ann Emerg Med 1997; 30(3):260–265.
Spence LJ et al. J Pediatr Surg 1993; 28(2):214–216.
Winston FK et al. Arch Pediatr Adolesc Med 2002; 156(9):922–928.
Unal VS et al. J Trauma 2006; 60(1):224–226; discussion 226.
Sanchez JI, Paidas CN. Surg Clin North Am 1999; 79(6):1503–1535.
Demetriades D et al. J Am Coll Surg 2004; 199(3):382–387.
Taylor GA, Eich MR. Ann Surg 1989; 210(2):229–233.
Karmy-Jones R et al. Ann Thorac Surg 2003; 75(5):1513–1517.
Kram HB et al. Ann Thorac Surg 1989; 47(2):282–286.
Holmes JF et al. Ann Emerg Med 2002; 39(5):492–499.
Perez FG, O‘Malley KF, Ross SE. Ann Emerg Med 1991; 20(5):500–502.
Moss RL, Musemeche CA. J Pediatr Surg 1996; 31(8):1178–1181; discussion 1181–1182.
Hennes HM et al. Pediatrics 1990; 86(1):87–90.
Adamson WT et al. J Pediatr Surg 2003; 38(3):354–357; discussion 354–357.
Bass DH, Semple PL, Cywes S. J Pediatr Surg 1991; 26(2):196–200.
Grosfeld JL, Cooney DR. Pediatr Clin North Am 1975; 22(2):365–377.
Mehall JR et al. J Am Coll Surg 2001; 193(4):347–353.
Puranik SR et al. South Med J 2002; 95(2):203–206.
Tepas JJ 3rd et al. Ann Surg 2003; 237(6):775–780; discussion 780–781.
Silber JS et al. J Pediatr Orthop 2001; 21(4):446–450.
Abou-Jaoude WA et al. J Pediatr Surg 1996; 31(1):86–89; discussion 90.
Brown SL et al. World J Surg 2001; 25(12):1557–1560.
Perez-Brayfield MR et al. J Urol 2002; 167(6):2543–2546; discussion 2546–2547.
Lieu T et al. Pediatrics 1988; 82(2):216–222.
Taylor GA, Eichelberger MR, Potter BM. Ann Surg 1988; 208(6):688–693.
Stylianos S. J Pediatr Surg 2000; 35(2):164–167; discussion 167–169.
Anderson SW et al. Radiology 2008; 246(2):410–419.
Anderson SW et al. Emerg Radiol 2007; 14(3):151–159.
Anderson SW et al. Radiology 2007; 243(1):88–95.
Wessel LM et al. J Pediatr Surg 2000; 35(9):1326–1330.
Brody AS et al. Pediatrics 2007; 120(3):677–682.
Hall EJ, Brenner DJ. Br J Radiol 2008; 81(965):362–378.
Sivit CJ et al. Radiology 1992; 182(3):723–726.
Maturen KE et al. J Trauma 2007; 62(3):740–745.
Puapong D et al. J Pediatr Surg 2006; 41(11):1859–1863.
Rozycki GS et al. J Trauma 2002; 52(4):618–623; discussion 623–624.
Strouse PJ et al. Radiographics 1999; 19(5):1237–1250.
Kawashima A et al. Abdom Imaging 2002; 27(2):199–213.
Sivit CJ. Pediatr Radiol 2000; 30(2):99–100.
Brown SL, Hoffman DM, Spirnak JP. J Urol 1998; 160(6 Pt 1):1979–1981.
Snajdauf J et al. Eur J Pediatr Surg 2007; 17(5):317–321.
Allen GS et al. J Trauma 1998; 45(1):69–75; discussion 75–78.
Ulman I et al. J Trauma 1996; 41(1):110–113.
Ozturk H et al. Surg Today 2003; 33(3):178–182.
Ghali AM et al. J Trauma 1999; 46(1):150–158.
Yale-Loehr AJ et al. Am J Roentgenol 1989; 152(1):109–113.
Santucci RA, Langenburg SE, Zachareas MJ. J Urol 2004; 171(2 Pt 1):822–825.
Nance M. et al. J Trauma 2004; 57(3): 474–478; discussion 478.
Abdalati H et al. Pediatr Radiol 1994; 24(8):573–576.
Gross M et al. J Pediatr Surg 1999; 34(5):811–816; discussion 816–817.
Rovin JD et al. Am Surg 2001; 67(2):127–130.
Katz S et al. J Pediatr Surg 1996; 31(5):649–651.
Lynch J. et al. J Pediatr Surg 1997; 32(7):1093–1095; discussion 1095–1096.
Cochran A et al. Am J Surg 2004; 187(6):713–719.
Minarik L et al. Pediatr Surg Int 2002; 18(5–6):429–431.
Milas ZL, Dodson TF, Ricketts RR. Am Surg 2004; 70(5):443–447.
Rozycki GS et al. J Trauma 2002; 52(4):618–623; discussion 623–624.
Spouge AR et al. Pediatr Radiol 1991; 21(5):324–328.
Tiao GM et al. J Pediatr Surg 2000; 35(11):1656–1660.
Eddy AC et al. J Trauma 1990; 30(8):989–991; discussion 991–992.
Bulloch B et al. Pediatrics 2000; 105(4):E48.
Stafford PW, Harmon CM. Curr Opin Pediatr 1993; 5(3):325–332.
Sartorelli KH, Vane DW. Semin Pediatr Surg 2004; 13(2):98–105.
Holmes JF et al. J Trauma 2001; 50(3):516–520.
Karaaslan T et al. J Trauma 1995; 39(6):1081–1086.
Ball C.G et al. J Trauma 2006; 60(2):294–298; discussion 298–299.
Masmoudi S et al. Arch Pediatr 2003; 10(5):436–438.
Manson D et al. Pediatr Radiol 1993; 23(1):1–5.
Donnelly LF, Klosterman LA. Radiology 1997; 204(2):385–387.
Sartorelli KH, McBride WJ, Vane DW. J Pediatr Surg 1999; 34(3):495–497.
Shehata SM, Shabaan BS. J Pediatr Surg 2006; 41(10):1727–1731.
Rees O, Mirvis SE, Shanmuganathan K. Clin Radiol 2005; 60(12):1280–1289.
Bergin D et al. Am J Roentgenol 2001; 177(5):1137–1140.
Koplewitz BZ et al. Pediatr Radiol 2000; 30(7):471–479.
Shanmuganathan K et al. Am J Roentgenol 1996; 167(2):397–402.
Mutabagani KH et al. J Pediatr Surg 1999; 34(1):48–52; discussion 52–54.
Stengel D, Bauwens K, Sehouli J, Rademacher G, Mutze S et al. Cochrane Database Syst Rev 2008; 4:1–25.
Valentino M. et al. Radiology, 2008.
Hackam D et al. J Pediatr Surg 2002; 37(3):386–389.
Lutz N et al. J Pediatr Surg 2004; 39(3):491–494.
Canty TG Sr, Weinman D. J Trauma 2001; 50(6):1001–1007.
Karp MP et al. J Pediatr Surg 1986; 21(7):617–623.
Balkan E, Kilic N, Dogruyol H. Int J Urol 2005; 12(3):311–312.
Ku JH et al. Int J Urol 2001; 8(6):261–267.
Moog R et al. J Urol 2003; 169(2):641–644.
Keller M et al. J Trauma 2004; 57(1):108–110; discussion 110.
Shilyansky J et al. J Pediatr Surg 1997; 32(6):880–886.
Albanese CT et al. J Trauma 1996; 40(3):417–421.
Atri M et al. Radiology 2008; 249(2):524–533.
Stuhlfaut JW et al. Radiology 2004; 233(3):689–694.
Sivit CJ, Eichelberger MR, Taylor JA. Am J Roentgenol 1994; 163(5):1195–1198.
Dokucu A et al. J Pediatr Surg 2000; 35(12):1799–1804.
McAleer IM, Kaplan GW. Urol Clin North Am 1995; 22(1):177–188.
Rehm CG et al. Ann Emerg Med 1991; 20(8):845–847.
Reinberg O, Yazbeck S. J Pediatr Surg 1989; 24(10):982–984.
Podesta ML, Jordan GH. J Urol 2001; 165(5):1660–1665.
Lynch JM, Gardner MJ, Albanese CT. Pediatr Emerg Care 1995; 11(6):372–375.
Tarman GJ et al. Urology 2002; 59(1):123–126; discussion 126.
Silber JS et al. J Pediatr Orthop 2001; 21(4):446–450.
Batislam E et al. J Trauma 1997; 42(2):285–287.
Emery KH et al. Radiology 1999; 212(2):515–518.
Eanniello VC 2nd et al. Conn Med 1994; 58(12):707–710.
Drasin TE, Anderson SW, Asandra A, Rhea JT, Soto JA. Am J Roentgenol 2008; 191:1821–1826.
Nance ML et al. J Trauma 2002; 52(1):85–87.
Venkatesh KR, McQuay N Jr J Trauma 2007; 62(1):216–220.
Levine CD et al. Am J Roentgenol 1996; 166(5):1089–1093.
Pershad J, Gilmore B. Pediatr Emerg Care 2000; 16(5):375–376.
Saggi BH et al. J Trauma 1998; 45(3):597–609.
Patel A et al. Am J Roentgenol 2007; 189(5):1037–1043.
Epelman M et al. Pediatr Radiol 2002; 32(5):319–322.
Al-Bahrani AZ et al. Clin Radiol 2007; 62(7):676–682.
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2010 Springer Science+Business Media, LLC
About this chapter
Cite this chapter
Mann, F., Gross, J.A., Blackmore, C.C. (2010). Imaging of Blunt Trauma to the Pediatric Torso. In: Medina, L., Applegate, K., Blackmore, C. (eds) Evidence-Based Imaging in Pediatrics. Springer, New York, NY. https://doi.org/10.1007/978-1-4419-0922-0_36
Download citation
DOI: https://doi.org/10.1007/978-1-4419-0922-0_36
Published:
Publisher Name: Springer, New York, NY
Print ISBN: 978-1-4419-0921-3
Online ISBN: 978-1-4419-0922-0
eBook Packages: MedicineMedicine (R0)