Paediatric Trauma Protocols
The RCR has now produced guidelines (ref no BFCR14(8)), endorsed by the College of Emergency Medicine, under the supervision of the Trauma Imaging Group.
Jude Foster's summary of the state of paediatric trauma imaging as of 20 November 2014 can be found HERE
The Trauma Imaging Group
The RCR guidelines for the management of severely injured patients mainly pertained to adults,
In developing guidelines for the imaging of the injured child the objectives were:
To define age group to which guidelines apply
Inclusion criteria for imaging of paediatric trauma – this may be quite different from adult criteria as children suffer a different spectrum of injury due to their differing biomechanics
To develop protocols for imaging paediatric trauma – which will include CT, ultrasound and plain radiographs
To consider the ionising radiation burden when imaging the paediatric patient.
Define reporting standards which can be universally applied.
Develop the guidelines by using evidence based data, where possible.
The Working Party was made up of:
Dr Jude Foster, Paediatric Radiologist, Chair
Dr Nick Ashford, RCR Treasurer
Dr Karl Johnson, Paediatric Radiologist, Birmingham
Dr Jo Danin, Paediatric Radiologist, Imperial, London
Dr Sam Negus, Paediatric Radiologist, St Georges London
Dr John Somers, Paediatric Radiologist, Nottingham
Dr Caren Landes, Paediatric Radiologist, Alderhey
Dr Chris Fitzsimmons, Consultant in Paediatric Emergency medicine, Sheffield
Dr Ross Fisher, Consultant Paediatric Surgeon, Sheffield
It is very important to work with your local medical physicist when optimising paediatric CT protocols. Things to consider
1) scan parameters - mA, kVp and pitch according to patients weight or age
2) Acceptable level of noise for "trauma scanning"
3)single phase acquisition with a dual contrast model – Bastion contrast wheel
4)use of iterative reconstruction, tube current modulation or organ based modulation where available.
5)protocols to reduce dose to particularly radiosensitive areas eg lens, where possible
6)use of breast and thyroid shields?
1. Assessment of paediatric CT dose indicators for the purpose of optimisation
Z Brady, F Ramanauskas, T M Cain and PN Johnston
The British Journal of Radiology, 85(2012), 1488-1498
Documents that were added to this section - December 2013
These are now part of the new document, but still available here separately. Please be aware that any updates will be in the full guidelines first, and these documents will not be updated immediately.
1. Contrast Wheel
2. Pro forma for Acute Primary Report for Paediatric Major Trauma
3.ED Paediatric Major Trauma Imaging Decision Tool
Link to TARNlet
Lagisetty J, Slovis T, Thomas R, Knazik S, Stankovic C. Are routine pelvic radiographs in major pediatric blunt trauma necessary? Pediatr Radiol (2012) 42:853–858
Rees M, Aickin R, Kolbe A, Teele RL. The screening pelvic radiograph in pediatric trauma.
Pediatr Radiol (2001) 31: 497-500
Donnelly LF Imaging issues in CT of blunt trauma to the chest and abdomen. Paediatr Radiol ( 2009) 39 ( Suppl 3 ) S406-S413
Summary: The role of CT is relatively limited to evaluation of Aortic injury
Holmes JF, Brant WE, Bogren HG et al. Prevalence and importance of pneumothoraces visualised on abdominal computed tomography scans in children with blunt trauma. J Traum 2001 50 (3) : 516-20
Brink M, Deunk J, Dekker HM et al. Added value of routine MDCT after blunt trauma :evaluation of additional findings and impact on patient management. Am J Roentgen 2008:190 ( 6) 1591-8
Summary: 7% of patients had a change in management as a result of a CT- repositioning of a chest tube or immoblisation of thoracic spine fracture
Patel RP, Hemanz- Schulman M, Hilmes MA, et al. Pediatric chest CT after trauma- impact on surgical and clinical management. Pediatr Radiol 2010; 40(7) 1246-53
4.7% had a change in management- insertion of chest drain – all but one seen on the upper abdo cuts
Renton J, Kincaid S, Ehrlich PF. Should helical CT scanning of the thoracic cavity replace the conventional chest x-ray as a primary assessment tool in pediatric trauma? An efficacy and cost analysis. J Pediatr Surg 2003; 38(5) :793-8