Whole-body CT doesn’t lower mortality in children with trauma like it does in adults

Though it’s been linked to reduced mortality in injured adults, emergent whole-body CT (WBCT) in lieu of selective imaging doesn’t seem to improve survival rates in children, researchers reported in JAMA Pediatrics this month.

For nearly three decades, computed tomography has been utilized as a diagnostic tool to identify trauma—the leading cause of death among American children—in young patients, lead author James A. Meltzer, MD, MS, and colleagues wrote in JAMA. Routine protocol used to lean toward selective CT scanning, the authors said, but a new trend is forming around WBCT.

“Some studies have suggested that the use of emergent whole-body CT, particularly in those with severe trauma, may improve survival by identifying occult injury that would otherwise not have been detected with selective CT scanning,” Meltzer et al. wrote. “As a result, the use of WBCT has increased considerably, becoming the standard imaging tool at many centers for patients who experience blunt trauma.”

There are a handful of physicians who currently recommend WBCT for both adults and children based on this evidence, but little data on the method’s efficacy in pediatric patients exists. Other doctors worry about the substantial amount of ionizing radiation a full-body CT would entail—radiation that’s often tolerated poorly by children since their organs are still developing and they have more time to manifest cancer risk.

“The lack of pediatric-specific data regarding WBCT has forced many clinicians to extrapolate the findings of adult studies to children,” the authors said. “Children have different injury patterns than adults, and many injuries identified on CT do not require an operation. Balancing the risk of occult, life-threatening injury and the risk of radiation-induced cancer is therefore a challenge.”

To test WBCT’s effectiveness in a younger population, Weltzer and co-authors sourced data for 42,912 children from National Trauma Data Bank. According to the retrospective study, kids ranged in age from 6 to 14 and had all experienced blunt trauma between 2010 and 2014.

To be eligible for the trial, all patients needed to have undergone an emergent CT within two hours of their arrival at the emergency department. Patients were only classified as having WBCTs if computed tomography was applied to the head, chest abdomen or pelvis in three separate scans; the rest underwent selective imaging.

More than a fifth of the study pool received a WBCT upon ER arrival, the researchers wrote. Less than 1 percent of patients—405 kids total—met the primary outcome of in-hospital mortality within a week of arrival.

After adjusting for the propensity score, Meltzer and colleagues found there was no significant difference in mortality between children who had undergone WBCT and those who’d had selective scanning. 

“This outcome was consistent regardless of how severely injured the children were,” the authors wrote. “Although WBCT may provide more information about the injured child, that information does not appear to be lifesaving. With growing concerns regarding excessive radiation exposure for injured children, physicians should attempt to limit CT exposure whenever possible.”