Paediatric considerations

For all paediatric trauma patients, PIPER is the first point of call to initiate retrieval and transfer or for advice (1300 137 650). PIPER will coordinate connection to the paediatric trauma line and retrieval services as required.
Most hospitals will perform some paediatric imaging, particularly in the rural setting. However the majority of imaging patients are likely to be adults. Imaging in the Paediatric population should be tailored so that required information is obtained with the fewest images and the least amount of radiation. The aim is to perform the most appropriate test the first time.8
Children are more sensitive to radiation exposure than adults, especially related to the thyroid breast tissue and gonads. There is a much longer life expectancy over which to express the radiation induced damaged to genes with girls being slightly more sensitive than boys. Radiography exposes children to relatively low doses of ionizing radiation while CT exposes them to the greatest.
All medical professionals must work towards the principles of ALARA (As Low As Reasonably Achievable) regarding radiation dose when utilising medical imaging, especially when it comes to children.

Trauma imaging

Three standard x-rays that should be considered routinely in major trauma:
  • lateral C-spine
  • chest
  •  pelvis (the desire to protect a child’s reproductive organs should not outweigh the risk of significant morbidity from a missed pelvic injury.  Any abdominal/lower limb/spinal trauma, all true multi-trauma patients (i.e. MCA/MBA with suspected multi-system trauma, etc.), all intubated patients or if the patient is difficult to assess they must have a plain pelvic radiograph. Always safer to do the radiograph if unsure.)
These x-rays are basic tests for major injuries. Full monitoring should be continued while obtaining the x-rays. Ideally these are done in the resuscitation room while the child is supervised by emergency staff.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              FAST FAST (Focused Assessment with Sonography in Trauma) scan: evidence suggests there is little value in paediatrics due to the risk of false reassurance, particularly when conducted by an inexperienced clinician. It may be useful only in structurally adult adolescents. The presence of free fluid in the abdomen on FAST does NOT mandate laparotomy. The absence of free fluid on FAST does NOT rule out significant intra-abdominal bleeding, therefore limiting its application.
eFAST (Extended FAST) scanning in children is helpful in diagnosing acute haemo/pneumothorax and haemopericardium when used by a skilled clinician.
Further imaging should only take place after discussion with PIPER.
CT Scanning: CT can be a life-saving tool for diagnosing injury in children and its use is steadily increasing. Despite this, one of the major disadvantages is the inevitable radiation exposure. The risk of developing a radiation-related cancer may be several times higher for a younger child compared to an adult. The benefits of a properly performed and clinically justified CT examination must always outweigh the risks for an individual child.9
The following principles should be engaged when deciding on imaging a child:
  • Ensure imaging is necessary
  • Ensure that the appropriate exam is requested
  • Communicate with the radiologist so that alternative modalities may be suggested
  • Adjust imaging parameters (radiographer)to keep radiation exposure low, but maintain diagnostic image quality
  • Only use IV contrast when absolutely necessary
It is strongly recommended that radiographers liaise with radiologists prior to taking plain x-rays if these are performed infrequently as well as for all CT’s. For CT, it is recommended that the radiologist consider whether ultrasound or MRI be performed as an alternative.
A radiologist is always available at RCH to discuss imaging if you are uncertain about the most appropriate imaging modality for urgent requests.
It is important not to perform a study, especially CT if it is unlikely that the child will be cooperative or satisfactorily immobilised. General anaesthesia and sedation requires the appropriate medical and nursing expertise, equipment and recovery facilities.
Transfer: The patient’s transfer to a definitive centre of care should not be delayed to await further imaging. If imaging has been completed prior to transferring the patient, then ensure CD’s or films accompany the patient so that repeated imaging is not performed, thereby exposing the patient to unnecessary radiation exposure and a delay in diagnosis.
For detailed advice regarding Paediatric imaging please follow the link: