Review of Current Pediatric Trauma Imaging Guidelines

The evaluation of injured children often involves imaging to assist in diagnosis and management. Many of these imaging tests involve exposure to ionizing radiation, which has been linked to future malignancies. Judicious use of diagnostic tests that expose a child to radiation is an important consideration when identifying children at risk for serious injury. Recognition of children who require a higher level of care and coordination with the receiving center should be a priority prior to obtaining advanced imaging. Detection of injury must be balanced with the risk of ionizing radiation in the pediatric trauma population. This principle has guided a field of pediatric trauma research and resulted in multiple guidelines and algorithms to assist in the diagnosis and management of traumatic injuries. Our review of recent literature shows reference to the Pediatric Emergency Care Applied Research Network (PECARN), Choosing Wisely recommendations, Pediatric Cervical Spine Clearance Working Group guidelines, as well as several recent studies guiding pediatric trauma. There is an emphasis on limiting the use of ionizing radiation imaging, the importance of clinical presentation guiding management, as well as understanding a center’s capabilities and ensuring expedited transfer to referral pediatric trauma centers. The “screen before you scan” approach using evidence-based clinical decision tools can assist in identifying pediatric patients who would benefit most from imaging. With the known risks of radiation in trauma patients, especially in children, more and more evidence-based clinical guidelines to “screen before you scan” are now being utilized to assist in identifying pediatric patients that can be managed with minimal use of ionizing radiation while maintaining safe clinically important injury detection rates while minimizing missed injuries.