Emergency Department Imaging of Pediatric Patients with Blunt Thoracic Trauma: A Systematic Review, Meta-Analysis, and Practice Management Guideline
In brief
Chest CT not needed for most pediatric blunt trauma with minor X-ray findings
In children under 18 who present after blunt chest injury and have no or only minor abnormalities on initial chest X-ray or bedside ultrasound, experts conditionally recommend against routine chest CT to look for injuries requiring surgery or causing death. This guidance rests on very low-quality evidence from three retrospective studies, highlighting the need for stronger data.
- Journal
- Journal of the American College of Emergency Physicians open (Q1)
- Published
- 28 July 2026
- Study design
- Systematic review of cohort studies
- Evidence level
- Level 2, Moderate (CEBM 2a)
- Authors
- Samuel H F Lam, Ilene Claudius, Jonathan H Valente, Brian K Yorkgitis, Ann M Dietrich, Rebecca J Wang, et al.
- PMID
- 42569217
- DOI
- 10.1016/j.acepjo.2026.100474
Why clinicians should know about it
- Picked for Emergency Medicine (paper of the day, 9 August 2026).
Abstract
Pediatric blunt torso trauma is a common reason for emergency department visits. Computed tomography (CT) is a highly sensitive tool for diagnosis of thoracic cavity injuries. However, the prevalence of thoracic injuries requiring intervention is lower in children compared with adults, and ionizing radiation from CT is associated with higher potential harms in this population. The role of screening chest x-ray and point-of-care ultrasound in identifying thoracic injuries requiring operative and procedural intervention has not been systematically reviewed previously. Four relevant questions related to imaging after blunt thoracic trauma in pediatric patients were developed using clearly defined Population (P), Intervention (I), Comparison (C), and appropriately selected Outcomes (O) (PICO). A systematic review and meta-analysis were conducted using the Grading of Recommendations Assessment, Development and Evaluation methodology. The multispecialty working group reached consensus on the final evidence-based recommendation. A total of 10,447 articles were screened, and data from 3 studies were included in the final meta-analysis. All the studies were retrospective in design, and the quality of the available evidence was determined to be very low. Based on the limited data, we were only able to make a recommendation on one of the 4 drafted PICO questions. In pediatric (<18 years) patients with blunt trauma presenting to the emergency department who have no or minor traumatic findings on initial screening chest imaging, we conditionally recommend that chest CT not be routinely used to identify thoracic injuries requiring procedural or operative intervention, or to identify thoracic injuries leading to mortality.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.