{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,29]],"date-time":"2026-07-29T05:30:16Z","timestamp":1785303016640,"version":"3.55.0"},"reference-count":10,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"1","content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":["Pediatr Emer Care"],"published-print":{"date-parts":[[2024,1]]},"abstract":"<jats:sec>\n            <jats:title>Objectives<\/jats:title>\n            <jats:p>Blunt trauma in pediatric patients accounts for a significant proportion of pediatric death from traumatic injury. Currently, there are no clinical decision-making tools available to guide imaging choice in the evaluation of pediatric patients with blunt thoracic trauma (BTT). This study aimed to analyze the rates of missed major intrathoracic injuries on chest x-ray (CXR) and identify clinical risk factors associated with major intrathoracic injuries to formulate a clinical decision-making tool for computed tomography (CT) use in pediatric patients with BTT.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Methods<\/jats:title>\n            <jats:p>We performed a retrospective single-center study using an institutional trauma database of pediatric patients. Inclusion criteria included age, blunt trauma, and patients who received a CXR and thoracic CT within 24 hours of presentation. Thoracic CT findings were graded as major, minor, or none, and comparison CXR was used to determine the rate of missed thoracic injuries. Eighty-four patient variables were then collected, and clinically relevant variables associated with major intrathoracic injuries were placed in a logistic regression model to determine the best predictors of major injury in pediatric BTT patients.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Results<\/jats:title>\n            <jats:p>A total of 180 patients (48.3%) had CXR that missed an injury that was seen on thoracic CT. In our cohort, 20 patients (5.4%) had major injuries that were missed on CXR. Characteristics correlating with major thoracic injuries were older age (odds ratio [OR], 1.125; 95% confidence interval [CI], 1.015\u20131.247), chest pain (OR, 4.907; 95% CI, 2.173\u201311.083), abnormal chest auscultation (OR, 3.564; 95% CI, 1.406\u20139.035), and tachycardia (OR, 2.876; 95% CI, 1.256\u20136.586). Using these 4 variables, receiver operating characteristic analysis revealed an area under the curve of 0.7903.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusions<\/jats:title>\n            <jats:p>Pediatric BTT patients older than 15 years with tachycardia, chest pain, or abnormal chest auscultation are at increased risk for major intrathoracic injuries and may benefit from thoracic CT.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1097\/pec.0000000000003102","type":"journal-article","created":{"date-parts":[[2023,12,29]],"date-time":"2023-12-29T19:00:11Z","timestamp":1703876411000},"page":"10-15","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":5,"title":["Clinical Predictors of Major Intrathoracic Injury in Pediatric Blunt Trauma"],"prefix":"10.1097","volume":"40","author":[{"given":"Stephen M.","family":"Gunnink","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alysa M.","family":"Butz","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jordan","family":"Griep","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mary","family":"Starrs","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Ponkowski","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jessica L.","family":"Parker","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christopher","family":"Benner","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"issue":"11 Suppl","key":"bib2-20250504","first-page":"S409","article-title":"Pediatric thoracic trauma","volume":"30","year":"2002","journal-title":"Crit Cre Med"},{"key":"bib3-20250504","doi-asserted-by":"crossref","first-page":"57","DOI":"10.1016\/S1010-7940(01)01056-9","article-title":"Chest trauma in children","volume":"21","year":"2002","journal-title":"Eur J Cardiothoracic Surg"},{"key":"bib4-20250504","doi-asserted-by":"crossref","first-page":"1160","DOI":"10.1016\/S0140-6736(09)61558-0","article-title":"Identification of children at very low risk of clinically-important brain injuries after head trauma: a prospective cohort study","volume":"374","year":"2009","journal-title":"Lancet"},{"key":"bib5-20250504","doi-asserted-by":"crossref","first-page":"107","DOI":"10.1016\/j.annemergmed.2012.11.009","article-title":"Identifying children at very low risk of clinically important blunt abdominal injuries","volume":"62","year":"2013","journal-title":"Ann Emerg Med"},{"key":"bib6-20250504","doi-asserted-by":"crossref","first-page":"1465","DOI":"10.1001\/jama.2010.1408","article-title":"Use of advanced radiology during visits to US emergency departments for injury-related conditions, 1998-2007","volume":"304","year":"2010","journal-title":"JAMA"},{"key":"bib7-20250504","doi-asserted-by":"crossref","first-page":"1039","DOI":"10.1016\/j.jpedsurg.2020.09.003","article-title":"Chest x-ray vs. computed tomography of the chest in pediatric blunt trauma","volume":"56","year":"2021","journal-title":"Journal of Pediatric Surgery"},{"key":"bib8-20250504","doi-asserted-by":"crossref","first-page":"492","DOI":"10.1067\/mem.2002.122901","article-title":"A clinical decision rule for identifying children with thoracic injuries after blunt torso trauma","volume":"39","year":"2002","journal-title":"Ann Emerg Med"},{"key":"bib9-20250504","doi-asserted-by":"crossref","first-page":"613","DOI":"10.1097\/TA.0b013e31829bb7fe","article-title":"Chest x-ray as a screening tool for blunt thoracic trauma in children","volume":"75","year":"2013","journal-title":"J Trauma Acute Care Surg"},{"key":"bib10-20250504","doi-asserted-by":"crossref","first-page":"1268","DOI":"10.1016\/j.ajem.2013.04.021","article-title":"What is the clinical significance of chest CT when the chest x-ray result is normal in patients with blunt trauma?","volume":"31","year":"2013","journal-title":"Am J Emerg Med"},{"key":"bib11-20250504","doi-asserted-by":"crossref","first-page":"940","DOI":"10.1001\/jamasurg.2013.2757","article-title":"NEXUS chest: validation of a decision instrument for selective chest imaging in blunt trauma","volume":"148","year":"2013","journal-title":"JAMA Surg"}],"container-title":["Pediatric Emergency Care"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.lww.com\/10.1097\/PEC.0000000000003102","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,5,4]],"date-time":"2025-05-04T18:10:09Z","timestamp":1746382209000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.lww.com\/10.1097\/PEC.0000000000003102"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,1]]},"references-count":10,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2024]]}},"URL":"https:\/\/doi.org\/10.1097\/pec.0000000000003102","relation":{},"ISSN":["1535-1815","0749-5161"],"issn-type":[{"value":"1535-1815","type":"electronic"},{"value":"0749-5161","type":"print"}],"subject":[],"published":{"date-parts":[[2024,1]]}}}