Study objectives: (1) To determine whether chest CT
provides additional information compared with chest radiography
regarding the nature of intrathoracic disease in critically ill
children, (2) to determine whether such information alters clinical
management, (3) to assess the role of a low-dose high-resolution CT
(HRCT) protocol in pediatric ICU (PICU) patients.
Design: Prospective study.
Specialized PICU in a teaching hospital serving London and the south of
Patients: Twenty children (age range, 3 weeks
to 12 years; median, 11 months) underwent chest CT during a 33-month
period. Inclusion criteria were (1) inconclusive diagnosis from chest
radiograph (CXR) or (2) CXR appearances inconsistent with high
oxygenation or ventilatory requirements (Pao2
to fraction of inspired oxygen ratio < 30 or mean airway pressure>
15 cm H2O).
HRCT scans (50 mA, 2-mm slice thickness at intervals of 10 or 15 mm)
were performed on 12 patients, and helical CT (50 to 250 mA; pitch, 1
to 1.5) performed on 8 patients.
results: CT provided additional information regarding the nature
of intrathoracic disease in 17 of 20 patients (85%) and resulted in
changes to subsequent clinical management in 12 of 20 patients
Conclusions: Chest CT can add to the accuracy
of intrathoracic diagnosis provided by the CXR and may directly
influence the acute management of critically ill children. The CT
protocol should be tailored to the clinical and radiologic question
posed for each individual patient. Noncontiguous HRCT can often provide
accurate assessment of pulmonary parenchymal and pleural disease at a
reduced radiation dose compared with helical CT.