Pediatric Emergency Medicine FEllow Nemours Children's Hospital Delaware Valley Wilmington, Delaware, United States
Background: The NEXUS Chest and NEXUS Chest CT rules were developed to help identify trauma patients at low risk for significant thoracic injury for which imaging could safely be avoided. However, these clinical decision tools were derived and validated only in patients older than 14 years of age. Objective: To identify pediatric trauma patients at very low risk of clinically significant thoracic injury for whom chest CT might be unnecessary. Design/Methods: We performed a retrospective cohort study of patients 0-18 years old who presented with blunt trauma to 2 tertiary care pediatric emergency departments between January 2012-March 2023. The locations included a pediatric emergency department with a Level 1 trauma center in Wilmington, DE and a pediatric emergency department with a Level 2 trauma center in Orlando, FL. The study was approved by Nemours Institutional Review Board. Patients who presented within 24 hours of blunt trauma and had a chest x-ray and chest CT performed were included. We excluded children with penetrating trauma or chest mass. Patient demographics, historical and clinical factors, diagnostic imaging, interventions, patient outcomes, and disposition were manually extracted. Very low risk or no clinically significant thoracic injury was defined as meeting one of the two following conditions: 1. No injury identified on chest x-ray or chest CT. 2. Injury noted on imaging that did not require surgical intervention or hospital admission. Unviariate and multivariate analysis will be used to create a model to predict children at low risk for clinically significant injury for whom chest CT may be deferred. One hundred fifty patients met study inclusion criteria. We plan to complete data abstraction by November 30, 2023 and statistical analysis by January 30, 2024. Results and discussion will be completed by March 30, 2024.
.jpg "Brittney Russell, D.O. (she/her/hers) photo")