Is the rate of chest computed tomography different between adult and pediatric Level 1 trauma centers?

Abstract

Injured children receive trauma care at both children's hospitals and adult trauma centers. The established risk that radiation poses to children mandates minimizing exposure whenever possible. Several studies show chest computed tomography (CCT) rarely alters management of children with suspected thoracic trauma when the chest radiograph (CXR) is normal. We hypothesize that adult trauma centers overutilize CCT for children with suspected blunt thoracic trauma. We conducted a retrospective review of the Pennsylvania Trauma System Foundation database for all children below 15 years old sustaining blunt trauma between 2019 and 2023. Patients who presented to Level 1 pediatric regional trauma centers (PTC) (n=3) were compared with adult Level 1 trauma centers (ATC) (n=10); transfers were excluded. ICD-10 procedure codes were used to identify patients with any interventions on the chest. The query identified 1,241 qualified patients, 850 treated at PTCs and 391 at ATCs. PTC patients were younger with a higher injury severity score (ISS). There was a decreased rate of CCT at PTCs (10.94% vs. 19.18%, p<0.0001). Subgroup analysis revealed a difference in CCT rate for ages 10-14 (18.33% vs. 35.97%, p<0.0001). PTCs also had a higher rate of thoracostomy tube placement (10.75% vs. 1.48%, p=0.002), but there were no differences in intubation, cardiopulmonary arrest, thoracotomy, or sternotomy. Subgroup analysis of patients with a length of stay <3 days showed no differences in age, ISS, or interventions; however, the rate of CCT was higher at ATCs (6.58% vs. 25.77%, p<0.0001). CCT rates were lower across all age groups in the PTC cohort despite PTCs having a higher ISS score. Interestingly, there continued to be decreased CCT use at PTCs for children who were admitted for less than 3 days. Our findings support the hypothesis that adult trauma centers overutilize CCT in children suspected of blunt thoracic trauma. (J Trauma Acute Care Surg 2026;00:000-000. Copyright © 2026 Wolters Kluwer Health, Inc. All rights reserved.). Level III.