The assessment of trauma in children is challenging due to difficulties in obtaining
information about the mechanism and process of trauma, which leads doctors to perform
more imaging. Although the incidence of fatal injuries in children has decreased in the
last decade, trauma-related injuries remain a leading cause of death among children over
one-year-old. Due to the lower imaging threshold in children compared to adults,
whole-body computed tomography (WBCT) is frequently used. WBCT is an essential tool for
the rapid diagnosis of injuries, especially in hemodynamically unstable pediatric
multi-trauma patients.
The most accurate criteria for activating the trauma team in pediatric trauma patients
are still being debated. According to the Advanced Trauma Life Support (ATLS) guidelines,
the trauma team is activated based on the mechanism of injury; thus, WBCT is performed
even in hemodynamically stable pediatric patients. This situation leads to unnecessary
radiation exposure, increased costs, and resource wastage. Although the mechanism of
injury does not constitute a sufficient indication for WBCT in pediatric patients, many
trauma patients are evaluated with WBCT to avoid missing potential injuries.
In pediatric emergency department patients, it is known that WBCT is not associated with
a reduction in mortality but is linked to high radiation exposure and increased lifetime
risk for leukemia, solid cancers, and brain tumors. Therefore, although we know the
benefits of targeted emergency CT scans, the usefulness of WBCT imaging for pediatric
trauma patients is debated.
The severity of injuries, especially in multi-trauma patients, is classified using the
Injury Severity Score (ISS). The ISS is based on an anatomical ordinal scale ranging from
1 to 75 points, with low scores representing mild injuries and high scores representing
severe and fatal injuries. Generally, an ISS >15 indicates serious injuries. This scoring
system is also applicable to children and adolescents. However, pediatric patients show
lower mortality for the same ISS compared to adults, attributed to physiological response
differences between adults and children. Therefore, a new classification for injury
severity in pediatric patients has been proposed. While an ISS >15 in adults indicates
serious injury, an ISS >23 in the pediatric population indicates serious injury, and
patients with an ISS >26 may have functional impairments at discharge.
To reduce unnecessary radiation exposure and prevent resource wastage in pediatric trauma
patients, a new study was conducted by Strahl and colleagues. The study involved
pediatric emergency patients with high-energy trauma mechanisms at a Level I trauma
center in Germany. As a result of this study, a pediatric polytrauma CT indication score
(PePCI) was developed to analyze pediatric trauma patients and reduce radiation exposure.
The performance of this score was compared with the ISS. In this study, cases were
screened retrospectively. It was found that WBCT was applied to 243 pediatric trauma
patients. If the PePCI score had been applied to pediatric trauma patients, it could have
been determined that WBCT would not have been necessary for 76 of the 243 patients they
screened. Moreover, no significant injuries would have been overlooked.
Another single-center study conducted by Davies and colleagues in the United Kingdom (UK)
demonstrated that a large patient group in the UK is exposed to unnecessary radiation.
This situation is thought to increase the risk of life-threatening outcomes, such as
malignancy, in the future. With appropriate evaluation, it has been shown that WBCT
imaging may not be necessary for some trauma patients. A scoring system called the
Manchester Trauma Imaging Score (ManTIS) has been developed to facilitate this
evaluation. The ManTIS score has been shown to safely reduce the number of unnecessary
WBCTs in the young patient group.
Although these studies have shown that the PePCI and ManTIS scores effectively predict
the need for WBCT and prevent unnecessary scans, they have been conducted in a single
region. The developed scoring systems are only applicable to specific geographical areas.
Additionally, both studies were retrospective. Therefore, this study plans to
prospectively evaluate the reliability, applicability, and practicality of these scores
in clinical practice in Türkiye, assessing their real-life benefits.
