{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,18]],"date-time":"2026-03-18T09:55:59Z","timestamp":1773827759001,"version":"3.50.1"},"reference-count":29,"publisher":"MDPI AG","issue":"6","license":[{"start":{"date-parts":[[2026,3,17]],"date-time":"2026-03-17T00:00:00Z","timestamp":1773705600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"\u201cVictor Babes\u201d University of Medicine and Pharmacy, Timisoara"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diagnostics"],"abstract":"<jats:p>Background\/Objectives: Pediatric thoracic trauma requires prompt stabilization and timely imaging; however, actual sequencing and escalation triggers are infrequently delineated at the pathway level. The aim of this study was to analyze imaging pathways observed in routine clinical practice at our institution and to outline a preliminary escalation framework integrating injury mechanism, clinical severity, and initial ultrasound findings. Methods: A retrospective cohort study was conducted at the \u201cLouis \u021aurcanu\u201d Clinical Emergency Hospital for Children, Timi\u0219oara, Romania, including 66 children admitted with primary thoracic trauma between January 2022 and December 2024. Clinical trajectory markers (transfer-in, ICU admission, length of stay) and imaging utilization\/sequencing (FAST, CXR, CT, MRI\/CTA) were extracted. We divided injuries into two groups: bony (like fractures of the clavicle or scapula) and non-bony. CT escalation was characterized as a chest CT conducted upon admission. Fisher\u2019s exact and Mann\u2013Whitney U tests were used for comparative analyses. Results: FAST was done on all patients but was infrequently positive. Imaging followed heterogeneous but structured patterns, most commonly FAST with CXR, with or without CT. A large group of them had CT scans without first having any X-rays. CT escalation was associated with fracture-pattern injuries and higher-acuity trajectories (transfer-in and ICU admission), as well as prolonged hospital stays. Pathway-level assessment demonstrated that CT escalation effectively captured bony injury patterns, whereas FAST proficiently sorted ICU-level trajectories. Conclusions: Pediatric thoracic trauma imaging functioned as a selective escalation system: FAST served as a universal bedside entry step, and CT operated as an injury pattern- and acuity-linked severity gate. Making this escalation logic clear may help with standardization while still protecting against radiation.<\/jats:p>","DOI":"10.3390\/diagnostics16060889","type":"journal-article","created":{"date-parts":[[2026,3,17]],"date-time":"2026-03-17T14:50:48Z","timestamp":1773759048000},"page":"889","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Imaging Pathways in Pediatric Thoracic Trauma: FAST-First Triage and Selective CT Escalation in Clinical Practice"],"prefix":"10.3390","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5863-6613","authenticated-orcid":false,"given":"Emil Radu","family":"Iacob","sequence":"first","affiliation":[{"name":"Department of Pediatric Surgery and Orthopaedics, \u2018Victor Babe\u0219\u2019 University of Medicine and Pharmacy, 300041 Timi\u0219oara, Romania"},{"name":"Department of Pediatric Surgery and Orthopaedics, \u2018Louis \u021aurcanu\u2019 Emergency Clinical Hospital for Children, 300011 Timi\u0219oara, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4620-3340","authenticated-orcid":false,"given":"Emil Robert","family":"Stoicescu","sequence":"additional","affiliation":[{"name":"Department of Radiology and Medical Imaging, \u2018Victor Babe\u0219\u2019 University of Medicine and Pharmacy, 300041 Timi\u0219oara, Romania"},{"name":"Research Center for Medical Communication, \u2018Victor Babe\u0219\u2019 University of Medicine and Pharmacy, Eftimie Murgu Square No. 2, 300041 Timi\u0219oara, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Valentina Adriana","family":"Marcu","sequence":"additional","affiliation":[{"name":"Department of Pediatric Surgery and Orthopaedics, \u2018Louis \u021aurcanu\u2019 Emergency Clinical Hospital for Children, 300011 Timi\u0219oara, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2894-712X","authenticated-orcid":false,"given":"Roxana","family":"Stoicescu","sequence":"additional","affiliation":[{"name":"Research Center for Medical Communication, \u2018Victor Babe\u0219\u2019 University of Medicine and Pharmacy, Eftimie Murgu Square No. 2, 300041 Timi\u0219oara, Romania"},{"name":"Department of Anatomy and Embriology, \u2018Victor Babe\u0219\u2019 University of Medicine and Pharmacy, 300041 Timi\u0219oara, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Vlad","family":"Predescu","sequence":"additional","affiliation":[{"name":"Orthopaedics and Traumatology Department, Ponderas Academic Hospital, 014142 Bucharest, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9012-321X","authenticated-orcid":false,"given":"Narcis Flavius","family":"Tepeneu","sequence":"additional","affiliation":[{"name":"Department of Pediatric Surgery and Orthopaedics, \u2018Victor Babe\u0219\u2019 University of Medicine and Pharmacy, 300041 Timi\u0219oara, Romania"},{"name":"Department of Pediatric Surgery and Orthopaedics, \u2018Louis \u021aurcanu\u2019 Emergency Clinical Hospital for Children, 300011 Timi\u0219oara, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6784-0165","authenticated-orcid":false,"given":"Maria Corina","family":"Stanciulescu","sequence":"additional","affiliation":[{"name":"Department of Pediatric Surgery and Orthopaedics, \u2018Victor Babe\u0219\u2019 University of Medicine and Pharmacy, 300041 Timi\u0219oara, Romania"},{"name":"Department of Pediatric Surgery and Orthopaedics, \u2018Louis \u021aurcanu\u2019 Emergency Clinical Hospital for Children, 300011 Timi\u0219oara, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mihai Cristian","family":"Neagu","sequence":"additional","affiliation":[{"name":"Department of Pediatric Surgery and Orthopaedics, \u2018Victor Babe\u0219\u2019 University of Medicine and Pharmacy, 300041 Timi\u0219oara, Romania"},{"name":"Department of Pediatric Surgery and Orthopaedics, \u2018Louis \u021aurcanu\u2019 Emergency Clinical Hospital for Children, 300011 Timi\u0219oara, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5169-256X","authenticated-orcid":false,"given":"Adrian","family":"Georgescu","sequence":"additional","affiliation":[{"name":"Faculty of Physical Education and Sport, \u2018Ovidius\u2019 University of Constan\u021ba, 900470 Constan\u021ba, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Calin Marius","family":"Popoiu","sequence":"additional","affiliation":[{"name":"Department of Pediatric Surgery and Orthopaedics, \u2018Victor Babe\u0219\u2019 University of Medicine and Pharmacy, 300041 Timi\u0219oara, Romania"},{"name":"Department of Pediatric Surgery and Orthopaedics, \u2018Louis \u021aurcanu\u2019 Emergency Clinical Hospital for Children, 300011 Timi\u0219oara, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2026,3,17]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"451","DOI":"10.1007\/s00068-022-02088-6","article-title":"Epidemiology, patterns, and mechanisms of pediatric trauma: A review of 12,508 patients","volume":"49","author":"Cintean","year":"2023","journal-title":"Eur. 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