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Trauma Imaging

 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.


The guidelines are available from the RCR website HERE or directly from our storage HERE.


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


CT optimisation


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?


References

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

Download the Wheel


2. Pro forma for Acute Primary Report for Paediatric Major Trauma

Download this Pro forma


3.ED Paediatric Major Trauma Imaging Decision Tool

Download the Tool


Link to TARNlet

References

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

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