Prevalence and importance of pneumothoraces visualized on abdominal computed tomographic scan in children with blunt trauma

Background: Chest radiographs are routinely obtained far the identification of pneumothoraces in trauma patients. Computed tomographic (CT) scanning h as a higher sensitivity for the detection of pneumothoraces, but the preval ence and importance of pneumothoraces detectable by CT scan but not by ches t radiography in children sustaining blunt trauma is unclear, Methods: We conducted a prospective observational cohort study of children less than 16 years old with blunt trauma undergoing both abdominal CT scan and chest radiography in the emergency department of a Level I trauma cente r over a 28-month period. All abdominal CT scans were interpreted by a sing le faculty radiologist. The chest radiographs of all patients with pneumoth oraces detected on CT scan as web as a random sample of chest radiographs f rom pediatric blunt trauma patients without pneumothoraces on abdominal CT scan (in a ratio of four normals per pneumothorax) were reviewed by a secon d faculty radiologist. Both radiologists were masked to all clinical data a s well as to the objective of the study. Results: Five hundred thirty -eight children underwent both abdominal CT sc an and chest radiography in the emergency department. Twenty patients (3.7% ; 95% confidence interval [CI], 2.3-5.7%) were found to have pneumothoraces on CT scan. Of these 20 patients, 9 (45%; 95% CI, 23-68%) had pneumothorac es identified on initial chest radiography and 11 patients did not ("unsusp ected pneumothoraces"), Twelve pneumothoraces were identified in these 11 p atients; 6 were graded as minuscule and 6 as anterior according to a previo usly established scale, One patient with an unsuspected pneumothorax underw ent tube thoracostomy, None of the 10 patients (0%; 95% CI, 0-26%) with uns uspected pneumothoraces who were managed without thoracostomy (including tw o patients: who underwent positive pressure ventilation) had complications from their pneumothoraces, Conclusion Less than half of pediatric blunt trauma patients with pneumotho races visualized on abdominal CT scan had these pneumothoraces identified o n initial chest radiograph, Patients with pneumothoraces identified solely on abdominal CT scan, however, uncommonly require tube thoracostomy.