Whole-body CT in pediatric trauma: radiation exposure and imaging findings in a retrospective cohort

Introduction: Whole-body computed tomography (WBCT) is increasingly used in the evaluation of pediatric trauma; however, its clinical benefit remains controversial due to concerns regarding radiation exposure. This study aimed to evaluate the use of WBCT in pediatric trauma patients and to investigate its association with injury severity, radiation exposure, and clinical outcomes.Methods: This retrospective study included 791 pediatric trauma patients between 2019 and 2020. Patients were categorized into WBCT (n = 93) and non-WBCT (n = 698) groups. Injury severity was assessed using the Abbreviated Injury Scale (AIS) and Injury Severity Score (ISS). Radiation dose was estimated using dose-length product conversion coefficients. CT findings and patient disposition were compared between groups.Results: Patients undergoing WBCT had significantly higher injury severity scores and radiation exposure than those in the non-WBCT group (p < 0.001). The mean effective radiation dose was significantly higher in the WBCT group (11.63 ± 10.32 mSv) than in the non-WBCT group (2.92 ± 2.89 mSv) (p < 0.001). When stratified by CT scanner generation, radiation dose remained significantly higher in the WBCT group for both older-generation scanners (14.33 ± 9.99 vs. 3.23 ± 2.58 mSv) and newer-generation scanners (7.35 ± 9.47 vs. 2.68 ± 3.09 mSv) (p < 0.001 for both). Overall, 738 of 791 patients (93.3%) had no pathological findings. Despite increased imaging and radiation exposure, hospital admission rates did not differ significantly between groups (3.2% vs. 2.7%; Fisher's exact test, p = 0.736).Conclusion: WBCT in pediatric trauma was associated with substantially increased radiation exposure. Although hospital admission rates were similar between groups, differences in injury severity limit definitive conclusions regarding the clinical benefit of WBCT. More selective, risk-based imaging strategies may help reduce unnecessary radiation exposure, supporting safer and more sustainable pediatric emergency care practices from a public health perspective.