Hermes
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HERMES
Hermes
# Springer-Verlag GmbH Germany, part of Springer Nature 2020
Utilization of CT imaging in minor pediatric head, thoracic, and abdominal trauma in the United States Strait L, Sussman R, Ata A et al J Pediatr Surg (2020) 55:1766–1772 Effective doses for CT are decreasing but unindicated CT in children still carries a radiation burden and is not warranted. The purpose of this study was to quantify the use of CT scans of the head, thorax and abdomen at trauma centers in children who were in retrospect found to have no injury or only minor to moderate injuries and in whom the need for intervention was unlikely. The authors queried the National Trauma Databank between 2014 and 2016 to identify children who had suffered trauma and who were 14 years of age or younger. Of 257,661 children who were entered into the database, overall CT utilization was 20% for head, 5% for chest and 9% for abdomen and pelvis. Graded according to the Abbreviated Injury Scale (AIS) children with no injuries or minimal injury to the head were scanned 7% and 46% of the time, respectively, to the chest 3% and 13% and to the abdomen 6% and 30%. Among all patients, including all levels of injury and all scanned body parts, pediatric-focused standalone dedicated practices with level 1 designation had significantly lower CT utilization rates than adult-focused or combined adult/ pediatric practices. The authors concluded that CT scans at a level of injury in which the scans are unlikely to change therapy are still occurring, particularly in places that are not standalone pediatric-focused practices. The authors also opined that their data support the development of evidencebased guidelines to direct best practices. Pediatric chondroblastoma and the need for lung staging at presentation Arkader A, Williams A, Binitie O et al J Pediatr Orthop (2020) 40:e894–897 Chondroblastomas have traditionally been considered benign, hence no need for a staging chest CT, although there is a reported chance as high as 3% of lung nodules in these patients in mostly adult small series and case reports. To address the persistent question of the potential need for chest staging at
diagnosis, the authors undertook a retrospective study of the largest cohort of pediatric-exclusive chondroblastoma in the literature. This was a multi-institutional, international retrospective study of children and adolescents with chondroblastoma and included a total of 130 children (94 boys and 36 girls), with a mean age of 14.5 years, who underwent chest imaging at diagnosis. The authors reported that, despite minor differences in management among the participating institutions, the recurrence rate among all children was similar. However, none of the children developed pulmonary metastases (0/130). The authors concluded that the 3% metastatic frequency quoted in the literature is unproven and that it is probably much lower, estimating it to be at most 0.4% (0/333 cases in pediatric-exclusive series, 7/1,625 overall). Based on these data, the authors recommended against agg
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