Purpose or Case Report: 1) To understand penetrating injury in pediatric patients and how the child’s body habitus is more susceptible to multi organ injury than that of adult.
2) To explain the role of computed tomography (CT) in a pediatric penetrating trauma triage algorithm.
3) To discuss optimization of CT protocols in pediatric trauma patients based on the mechanism of injury with attention to radiation dose reduction.
4) To review the imaging findings in penetrating injuries to the chest, abdomen and pelvis.
Methods & Materials: Retrospective review of penetrating trauma cases in pediatric patients, 0-21 years of age, was performed. The cases were from two hospitals in New York metro area (level 1 and level 2 trauma centers).
Injuries were divided into high energy injury, such as gun shot, and low energy injury, such as stabbing. Injuries to the superficial soft tissues, musculoskeletal system, spine, head, and neck were excluded. Injuries of interest involve the chest, abdomen and pelvis, including vascular injuries are included as well. History and mechanism of injury, image findings as well as CT protocols were recorded.
Results: 18 cases of pediatric penetrating trauma were identified. 10 cases were classified as low energy and 8 were high energy injuries. Injuries involved solid organs such as the liver and spleen as well as hollow organs such as the colon and rectum. All were hemodynamically stable and underwent contrast enhanced CT imaging. All injuries were well delineated although imaging protocols varied depending on the mechanism of injury and suspected organ injured.
Conclusions: Penetrating trauma is a cause of severe injury in children. By utilizing optimized CT protocols, radiologists can achieve excellent image quality while reducing dose and making potentially life saving diagnoses.