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Computed tomography for evaluation of mild to moderate pediatric trauma: are we overusing it?
Anurag Jindal1, George C Velmahos, Roya Rofougaran
1Division of Trauma and Critical Care, Department of Surgery, University of Southern California and LAC+USC Medical Center, 1200 North State Street, Room 9900, Los Angeles, CA 90033, USA.
Insights
Pediatric trauma patients undergo more computed tomography (CT) scans than adults with similar injuries, primarily due to increased abdominal CT use. This liberal CT scanning policy for children with mild injuries increases costs without clear diagnostic or treatment benefits.
Area of Science:
- Medical Imaging
- Pediatric Trauma Care
- Health Resource Utilization
Background:
- Clinical examination in pediatric trauma is often deemed unreliable, leading to liberal use of computed tomography (CT).
- Appropriate resource utilization is critical in modern healthcare.
Purpose of the Study:
- To compare CT scan utilization in pediatric versus adult patients with mild to moderate trauma.
- To assess if increased CT use in children offers diagnostic or treatment advantages.
Main Methods:
- Matched cohort study comparing 108 pediatric patients (<7 years) with adult patients.
- Matching criteria included mechanism of injury, Injury Severity Score (ISS), and Abbreviated Injury Scores.
- Analysis focused on CT scan frequency, body areas scanned, and diagnostic yield.
Main Results:
- Pediatric patients received significantly more CT scans than matched adults, mainly due to liberal abdominal CT use.
- Multiple body area CT scans were more frequent in children but did not improve injury detection.
- No significant differences in outcomes (morbidity, mortality, length of stay) were observed between groups.
Conclusions:
- Liberal CT scanning for pediatric patients with mild to moderate trauma increases resource consumption.
- Current CT utilization practices in pediatric trauma may not provide commensurate diagnostic or treatment benefits.
- Further research into optimized imaging protocols for pediatric trauma is warranted.
Abstract:
Computed tomography (CT) is used liberally in the evaluation of pediatric trauma, even of low or moderate severity, because clinical examination of pediatric patients is considered unreliable. Appropriate utilization of valuable resources is essential in a cost-conscious medical era. The objective of this study is to determine if children with mild to moderate trauma are evaluated by more CT scans than adults with injuries of similar severity. Altogether, 108 pediatric patients less than 7 years old were matched according to mechanism of injury, Injury Severity Score (ISS), and the six individual body-region Abbreviated Injury Scores with adult patients admitted over the same 2-year period. All these patients had mild or moderate injuries (mean ISS 3.3 +/- 3.4). Pediatric patients had significantly more CT scans than adults, mostly because of a more liberal use of abdominal CT. CT scans of multiple body areas on the same patient were used more frequently in children but failed to identify more injuries compared to adults. None of the pediatric patients required an operation for abnormalities identified by CT. No differences were observed in morbidity, mortality, length of hospital stay, or length of intensive care unit stay for the two groups. It was concluded that a liberal policy of CT scanning for pediatric patients with a low ISS leads to increased resource consumption with no obvious diagnostic or treatment benefit.