Efficacy of Child Abuse Evaluations for Infants With Possible Subdural Hemorrhage Identified on Cranial Ultrasound Completed for Macrocephaly.

Abusive head trauma (AHT) is a significant cause of morbidity and mortality for infants. Determining when to pursue a complete physical abuse evaluation can be difficult, especially for nonspecific findings or when a child appears clinically well. This retrospective study of 7 cases sought to describe the presentation, evaluation, and diagnoses for infants with abnormal subdural collections identified on cranial ultrasound for macrocephaly, and to determine how frequently AHT is diagnosed. The results of this study showed that while each patient presented due to asymptomatic macrocephaly, the extent of the workup varied greatly. In addition, no infants had suspicious injuries for abuse during the initial evaluation or the year following. In summary, among the 7 patients seen for asymptomatic macrocephaly with possible subdural hemorrhage, there were very inconsistent child abuse workups. There needs to be a standardized clinical guideline for this specific patient population involving a child abuse pediatric evaluation.

Isolated computed tomography diagnosis of pulmonary contusion does not correlate with increased morbidity.

BACKGROUND: Increased utilization of computed tomography (CT) has led to a rise in the diagnosis of pulmonary contusion. Its clinical significance, in the absence of findings on chest radiograph (CXR), has not been defined. This study examines the clinical course of patients with CT-only diagnosis of pulmonary contusion and compares it with that of patients with CXR-proven pulmonary contusion. METHODS: The trauma database identified all children undergoing chest CT for blunt thoracic trauma during a 3-year period. Records were reviewed for age, mechanism of injury, Injury Severity Score (ISS), length of hospital stay (LOS), need for intensive care unit admission, and need for endotracheal intubation. A pediatric radiologist reviewed all films in a blinded fashion. Statistical analysis was performed using analysis of variance and Fisher's Exact test for 2 x 3 tables. RESULTS: Eighty-two patients were identified. There were no CXR-positive, CT-negative cases. A CT diagnosis of pulmonary contusion was made in 46 patients. Of these, 31 had a contusion on CXR as well (CXR+ group) and 15 had a normal CXR (CT+ only group). Mean ISS score did not differ significantly between the two groups (27 +/- 12.3 and 22 +/- 10.3, respectively). Thirty-six patients had a normal CT (control). Mean LOS was significantly longer in the CXR+ group (13 +/- 12.0 days) than in the CT+ only and control groups (5 +/- 3.6 and 9 +/- 9.5 days, respectively; P < .01). The percentages of children requiring intensive care unit admission and intubation were also significantly higher in the CXR+ group. CONCLUSION: The finding of pulmonary contusion by CT alone does not increase patient morbidity and appears to be of limited clinical significance.

Utility of simple radiation dose measurements in the evaluation of different CT scanners used for high-resolution CT.

In recent years radiation risk from CT scanning has become an important area of investigation. Many authors have suggested that radiation dose can be decreased without loss of diagnostic information. This dose reduction has primarily been achieved through a decrease in tube current. An area that has received little attention has been variations in dose from different CT scanners. To evaluate this aspect of radiation exposure, we measured the radiation dose of 4 different CT scanners. We found that the radiation dose for the same CT technique can vary by as much as a factor of 3 when 1 mm slices are used. CT dose variation was greatest for thin slices, making these observations particularly important for high-resolution CT. Our measurement technique used standard quality assurance equipment available in most radiology departments. Use of these measurements to assess the radiation dose from different CT scanners is an easily performed technique that may allow a decrease in radiation exposure in departments by choosing the most appropriate intra departmental CT scanner for specific indications.

Postmortem validation of imaging-derived formulas for prediction of fetal lung volume.

OBJECTIVE: To determine the validity of existing imaging-derived formulas for predicting the fetal lung volume (FLV). METHODS: In a consecutive series of postmortem lungs without pulmonary anomalies, the observed FLV (FLV(obs)) after inflation was correlated with individual fetal variables used in imaging-derived formulas. In addition, FLV(obs) was correlated with the predicted FLV calculated according to these same formulas. RESULTS: Postmortem FLV(obs) showed a strong correlation with estimated fetal body weight, biparietal diameter, and head circumference (r > 0.9). The correlation of FLV(obs) with gestational age, femur length, and liver weight was less strong (0.8 < r < 0.9). The correlation was strongest for midgestation fetuses (between 22 and 32 weeks' gestation). The predicted FLV calculated using formulas based on fetal body weight, biparietal diameter, and head circumference showed the strongest correlation with the actual FLV(obs) (r > 0.9). CONCLUSIONS: Postmortem FLV(obs) strongly correlates with fetal body weight, biparietal diameter, and head circumference, especially in midgestation fetuses. Regression formulas based on these fetal variables provide the most accurate prediction of FLV.