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Eur J Radiol. 2018 Aug;105:32-40. doi: 10.1016/j.ejrad.2018.05.022. Epub 2018 May 25.

Indication of whole body computed tomography in pediatric polytrauma patients-Diagnostic potential of the Glasgow Coma Scale, the mechanism of injury and clinical examination.

Author information

1
Department of Diagnostic and Interventional Radiology, Clinic of the Goethe University, Theodor-Stern-Kai 7, 60590 Frankfurt, Germany. Electronic address: claudia.frellesen@kgu.de.
2
Department of Diagnostic and Interventional Radiology, Clinic of the Goethe University, Theodor-Stern-Kai 7, 60590 Frankfurt, Germany.
3
Department of Trauma, Hand and Reconstructive Surgery, Clinic of the Goethe University, Theodor-Stern-Kai 7, 60590 Frankfurt, Germany.
4
Department of Biostatistics and Mathematical Modelling, Clinic of the Goethe University, Theodor-Stern-Kai 7, 60590 Frankfurt, Germany.

Abstract

OBJECTIVE:

To evaluate the diagnostic potential of the Glasgow Coma Scale (GCS), the mechanism of injury (MOI) and clinical examination (CE) for the indication of whole body computed tomography (WBCT) in pediatric polytrauma patients.

MATERIALS & METHODS:

100 pediatric polytrauma patients with WBCT were analysed in terms of age, gender, (MOI), GCS, detected injury, FAST, CE and Injury Severity Score (ISS). Correlations between all clinical variables and patient groups with (p+) and without (p-) injury were assessed.

RESULTS:

Mean age was 9.13 ± 4.4 years (28% female patients). Injury was detected in 71% of the patients, most commonly of the head (43%). There was no significant correlation between type or severity of MOI and ISS (p > 0.1). None of the clinical variables had a significant predictive effect on p+. The optimum discrimination threshold of GCS was at 12.5 relating to craniocerebral injuries. Severity of MOI and FAST showed best predictive effects on thoracic and abdominal pathologies, respectively, but with only low sensitivities (<20%).

CONCLUSION:

There is no clinical variable, which can be used as sole indication for WBCT in pediatric polytrauma patients. GCS had a significant predictive value for craniocerbral injuries and CCT is recommended at GCS ≤ 13.

KEYWORDS:

GCS; Indication; Mechanism of injury; Pediatric polytrauma patients; Whole body CT

PMID:
30017296
DOI:
10.1016/j.ejrad.2018.05.022
[Indexed for MEDLINE]

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