Is Whole-Body CT Associated With Reduced In-Hospital Mortality in Children With Trauma? A Nationwide Study

Pediatr Crit Care Med. 2019 Jun;20(6):e245-e250. doi: 10.1097/PCC.0000000000001898.


Objectives: We aimed to investigate whether whole-body CT for children with trauma is associated with a different mortality than only selective CT.

Design: A multicenter, retrospective cohort study.

Setting: Nationwide trauma registry from 183 tertiary emergency medical centers in Japan.

Patients: We enrolled pediatric trauma patients less than 16 years old who underwent whole-body CT or selective CT from 2004 to 2014.

Interventions: We classified the patients into a whole-body CT group if they underwent head, chest, abdomen, and pelvis CT and a selective CT group if they underwent at least one, but not all, of the above scans.

Measurements and main results: We analyzed data from 9,170 eligible patients (males, 6,362 [69%]; median age, 9 yr [6-12 yr]). Of these, 3,501 (38%) underwent whole-body CT. The overall in-hospital mortality was 180 of 9,170 (2.0%), that of patients who underwent whole-body CT was 102 of 3,501 (2.9%), and that of patients who underwent selective CT was 78 of 5,669 (1.4%). After adjusted multilevel logistic regressions and propensity score matching, the whole-body CT group demonstrated no significant difference in terms of in-hospital mortality compared with the selective CT group. The adjusted odds ratios (whole-body CT vs selective CT) for in-hospital mortality were as follows: multilevel logistic regression model 1 (1.05 [95% CI, 0.70-1.56]); multilevel logistic regression model 2 (0.72 [95% CI, 0.44-1.17]); propensity score-matched model 1 (0.98 [95% CI, 0.65-1.47]); and propensity score-matched model 2 (0.71 [95% CI, 0.46-1.08]). Subgroup analyses also revealed similarities between CT selection and in-hospital mortality.

Conclusions: In this nationwide study, whole-body CT was frequently used among Japanese children with trauma. However, compared with the use of selective CT, our results did not support the use of whole-body CT to reduce in-hospital mortality. Selective use of imaging may result in less radiation exposure and provide more benefits than whole-body CT to pediatric trauma patients.

Publication types

  • Multicenter Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Age Factors
  • Child
  • Child, Preschool
  • Comorbidity
  • Female
  • Hospital Mortality*
  • Humans
  • Infant
  • Injury Severity Score
  • Japan / epidemiology
  • Logistic Models
  • Male
  • Odds Ratio
  • Propensity Score
  • Retrospective Studies
  • Sex Factors
  • Socioeconomic Factors
  • Tertiary Care Centers
  • Tomography, X-Ray Computed / methods*
  • Wounds and Injuries / diagnostic imaging*
  • Wounds and Injuries / mortality*