Written by Vivian Lei
Obtaining a screening chest CT for thoracic aortic injury poses a higher risk of cancer than the likelihood of identifying an aortic injury in injured children.
Why does this matter?
Thoracic aortic injury is extremely rare following trauma in children. This study examines the incidence of thoracic aortic injuries in the pediatric population and weighs that risk against the risk of developing cancer from the radiation exposure associated with thoracic CT imaging.
Another opportunity to choose wisely
Investigators queried the Pediatric Health Information System (PHIS), an administrative database of 43 major children’s hospitals in the United States, for children diagnosed with thoracic aortic injury. Of 311,850 children admitted with traumatic injury between 2004 and 2014, 46 (0.015%) had a diagnosed thoracic aortic injury. The majority of injuries were related to blunt trauma, most commonly motor vehicle collisions (63%, n=29). In children who presented with aortic injuries, 22 (47.8%) patients underwent a chest CT during their trauma evaluation; and of these, 13 (59.1%) also underwent plain films of the chest. Of all admitted trauma patients, 40% (n=124,909) underwent a chest CT making the positive diagnosis rate for aortic injury by chest CT 0.018%, or 1.8/10,000. Investigators argue that since the reported estimated cancer risk from a chest CT is 25/10,000 for girls and 7.5/10,000 in boys, the likelihood of identifying a thoracic aortic injury on chest CT is substantially less than the estimated rate of subsequent ionizing radiation-induced cancer development in children, by at least a factor of 13 in girls and a factor of 4 in boys.
Does the incidence of thoracic aortic injury warrant the routine use of chest computed tomography in children? J Trauma Acute Care Surg. 2018 Oct 2. doi: 10.1097/TA.0000000000002082. [Epub ahead of print]
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