Optimizing Imaging in the Pediatric Trauma Patient, Part 1: Head and Neck Trauma - Trauma EXTRA Supplement (Trauma CME) -

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Publication Date: August 2021 (Volume 18, Supplement 8)

CME Credits: 4 AMA PRA Category 1 Credits™. CME expires 08/15/2024. This course is included with an Pediatric Emergency Medicine Practice subscription

Specialty CME Credits: Included as part of the 4 credits, this CME activity is eligible for 4 Trauma credits, subject to your state and institutional approval.

Authors

Peer Reviewer

PEDIATRIC TRAUMA EXTRA EDITOR-IN-CHIEF

Abstract

Trauma is the leading cause of death in the pediatric population and is among the most common reasons for ED visits by children. Imaging is an important tool for the diagnosis and management of pediatric trauma, but there are risks associated with exposure to ionizing radiation. In pediatric head and neck injuries, clinical findings and clinical decision tools can help inform selection of the most appropriate imaging modalities for the trauma patient, while also reducing unnecessary radiation exposure. This supplement reviews evidence-based recommendations for imaging decisions and interpretations in skull fractures, traumatic brain injuries, abusive head trauma, cervical spine injuries, and facial bone fractures. Examples demonstrating imaging modalities and specific findings for the types of injuries are also provided.

Introduction

Trauma is the leading cause of pediatric mortality and long-term disability in the United States; each year, nearly 8 million children are treated for injuries, resulting in approximately 8000 deaths and an annual financial impact estimated at >$50 billion.¹ Studies have demonstrated improved outcomes at pediatric centers or trauma programs that have fully integrated pediatric and trauma services; however, approximately 17 million children in the United States do not live within an hour of a pediatric trauma center.¹ Ultimately, the best approach to addressing the mortality and disability associated with pediatric trauma is injury prevention. Programs such as Safe Kids Worldwide^® educate parents, institutions, and clinicians about child safety, and provide resources on injury prevention. These programs play an important role in decreasing pediatric mortality from injury¹ and should be incorporated in all trauma programs.

Imaging remains a critical tool in the evaluation of pediatric trauma patients. The evaluation of a child with head and/or neck injuries involves consideration of the anatomic and biomechanical differences between children and adults, as well as assessment of the risks associated with exposure to ionizing radiation in pediatric patients. The use of clinical decision tools can help reduce unnecessary imaging in head injuries. In all types of pediatric head and neck injuries, the mechanism of injury and the clinical findings will inform imaging decisions. This supplement provides evidence-based recommendations for the selection of appropriate diagnostic imaging modalities for pediatric patients with skull fractures, traumatic brain injuries, abusive head trauma, cervical spine injuries, and facial bone fractures. Recommendations for management of these injuries are not included in the scope of this supplement.