Should helical CT scanning of the thoracic cavity replace the conventional chest x-ray as a primary assessment tool in pediatric XXXX ? An efficacy and cost analysis.

@entity1 @entity174 @entity1514 @entity764 @entity397 @entity6830 @entity130
BACKGROUND/PURPOSE: Findings from studies in the @entity130 literature suggest that thoracic computed tomography (TCT) scanning should replace conventional radiographs as an initial imaging modality. Limited data exist on the clinical utility and cost of TCT scans in pediatric @entity130 . Our current practice is to obtain TCT scans in those @entity1 at risk for @entity1514 . The purpose of this study is to examine what additional information TCT provides, how frequently it results in a change in clinical management, and a cost/benefit analysis. METHODS: @entity1 18 years old and younger that had both a Chest x-ray (CXR) and TCT scan in their initial workup were included. Indications for TCT scan were (1) any sign of @entity764 on CXR, (2) pathologic findings on physical examination of the chest, and (3) high impact force to chest wall. A @entity1 may have had one or more indications for a TCT scan. RESULTS: Between 1996 and 2000, 45 of 1,638 @entity130 @entity1 met study criteria. Indications for TCT included @entity764 on CXR (n = 27), findings on physical examination (n = 8) and high-impact force (n = 33). In 18 of the 45 (40%), injuries were detected with TCT imaging but not on CXR. These included contusions (n = 12), hemothorax (n = 6), pneumothorax (n = 5), widened @entity6830 (n = 4), rib @entity174 (n = 2), @entity397 (n = 1), and @entity130 (n = 1). In 8 @entity1 (17.7%) TCT imaging resulted in a change in clinical management. These included insertion of a chest tube (n = 5) aortography (n = 2) and operation (n = 1). Age, sex, injury severity score, mechanism, and indication for TCT could not predict differences between TCT and CXR (P >.05). In our institution, the cost of a TCT is  200, and the @entity1 charge is  906 ( 94 per CXR). Based on our study data 200 TCTs would need to be done for each clinically significant change, increasing @entity1 ( 180,000) and hospital ( 39,600) costs. CONCLUSIONS: Helical TCT is a highly sensitive imaging modality for the thoracic cavity; however, routine CXR still provides clinically valuable information for the initial @entity130 evaluation at minimal cost. TCT should be reserved for selected cases and not as a primary imaging tool.
