ROUTINE USE OF RADIOGRAPHY AND ARTERIAL BLOOD-GASES IN THE EVALUATIONOF BLUNT TRAUMA IN CHILDREN

Study objective: To evaluate the usefulness of routine radiographs and arterial blood gases in children with blunt trauma. Design: Retrospec tive chart review. Type of participants: Ninety patients who met triag e criteria for our trauma team evaluation and who were less than 15 ye ars old were evaluated. Patients with a Glasgow Coma Scale score (GCS) of 15 (ie, mild to moderately injured children) were the focus of thi s study. Methods: Children seen from May 1991 through August 1992 had charts reviewed systematically and within 24 hours of emergency depart ment evaluation. Standard radiologic evaluation, including cervical-sp ine, chest, and pelvic radiographs, as well as arterial blood gas anal ysis, were obtained. The severity of injury was graded according to th e Modified Injury Severity Scale. Results: The mean age of patients wa s 6.4 years, and the injuries observed were exclusively extremity frac tures. The correlation between physical examination findings and radio logic evaluation was assessed. Forty-three patients had an abnormal ph ysical examination tie, gross deformity, limitation of motion, or pain ), and 26 had a fracture identified on radiograph. Forty-seven patient s had a normal physical examination and none had a fracture identified on radiograph (P<.001; sensitivity of positive signs and symptoms, 10 0%; false-negative findings, 0%). Four patients with abnormal blood ga ses are described. No patient had any vascular or solid organ injury i dentified. Conclusion: In children with a GCS score of 15, selected ra diologic and laboratory tests based on clinical findings are recommend ed. Careful observation and repeat examinations by trained clinicians can select a group of children at low risk for occult injury.