In America’s culture wars (e.g., War on Drugs, War on Women, War on Christmas, etc.), few rise to the magnitude of the Emergency Physician vs. the consultant surgeon. The disagreement in necessity of CT radiography for minor trauma is well-documented, and even surgeons themselves admit to possibly overdoing it in their valorous quest for zero-miss.
This study has the conclusion we’d like to see – but not the evidence needed to fully support it. These authors from Denver performed a retrospective review of 174 pediatric trauma team activations, specifically evaluating the incidence of CT-identified injuries for four categories of patients. The cohort these authors focus on for their conclusions are those with no apparent injury and no abnormal vital signs, but were imaged (presumably, considering this is retrospective) based on “mechanism of injury”. Of the 66 patients who received any kind of CT imaging in the absence of objective indications, zero serious injuries were identified.
However, this MOI-indicated CT group was not exactly uninjured – over a third had a long bone fracture, and 9% had a skull fracture. In a group of children whose average age is 7, of whom half have a significant injury, it is hard to quibble retrospectively with the indications for each CT individually – even if all were ultimately negative. There is an obvious hint of truth that, yes, if MOI is the overriding justification for CT, it will result in an embarrassingly low incidence of true injury. In the end, this study only shows us we need to continue advancing our development of clinical evaluation instruments to improve yield and cost-effective care.
“Mechanism of injury alone is not justified as the sole indication for computed tomographic imaging in blunt pediatric trauma”