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Computed tomography scanning in pediatric trauma: opportunities for performance improvement and radiation safety
Charles W Hartin1, Jeffery M Jordan, Seth Gemme
1Department of Pediatric Surgical Services, Women & Children's Hospital of Buffalo, Buffalo, New York.
Insights
Most pediatric trauma CT scans occur at non-pediatric facilities, highlighting the need for radiation dose reduction. Pediatric trauma centers can improve care by sharing images and educating referring sites on optimal CT protocols.
Area of Science:
- Pediatric Radiology
- Trauma Imaging
- Radiation Safety
Background:
- Pediatric CT scanning protocols have evolved to reduce radiation exposure.
- CT scans are crucial for trauma evaluation but contribute significantly to cumulative radiation dose in children.
- This study examines CT utilization in pediatric trauma patients at initial presentation versus transfer to a pediatric trauma center.
Purpose of the Study:
- To determine the number, body areas, radiation dosage, and proportion of CT scans performed at referring non-pediatric facilities versus pediatric trauma centers (PTCs).
- To identify areas for improvement in pediatric trauma imaging protocols and radiation dose reduction.
Main Methods:
- Retrospective review of a trauma database for pediatric patients (0-17 years) evaluated between January 2000 and December 2010.
- Analysis included initial CT scans at referring facilities and subsequent scans at a Level I Pediatric Trauma Center (PTC).
Main Results:
- 1562 patients and 1335 CT scans were reviewed over 11 years.
- The majority of CT scans (70%) occurred at referring non-pediatric facilities.
- Head CT was the most frequent scan (52%), and 17.9% of scans were repeated at the PTC. Radiation dose information was largely absent from scans at non-pediatric facilities.
Conclusions:
- A significant proportion of pediatric trauma CT scans are performed at non-pediatric facilities, emphasizing the need for optimized scanning protocols and radiation dose reduction.
- Pediatric trauma centers have an opportunity to enhance care by facilitating image transfer and educating referring facilities on CT indications, dosage, and radiation reduction strategies.
Background:
Recently, pediatric CT scanning protocols have reduced radiation exposure in children. Because evaluation with CT scan after trauma contributes to significant radiation exposure, we reviewed the CT scans in children at both initial presentation at a non-pediatric facility and subsequent transfer to a level I pediatric trauma center (PTC) to determine the number of scans, body area scanned, radiation dosage, and proportion of scans at each facility.
Methods:
The trauma database was retrospectively reviewed for children aged 0 to 17 y initially evaluated for trauma at another facility and then transferred to our PTC for pediatric specialty care between January 2000 and December 2010.
Results:
A total of 1562 patients with 1335 CT scans were reviewed over an 11-y period. The majority of CT scans occur at the referring facility compared to the PTC in a ratio of 7:3. CT of the head was the most frequent scan obtained (52%), and 17.9% of CT scans were repeated at the PTC. Less than 1% of CT scans performed at the non-pediatric centers contained radiation dosage information, precluding analysis of radiation exposure.
Conclusions:
The majority of CT scans for trauma occur at non-pediatric facilities, which demonstrates the need for referring facilities to perform optimal CT scans with the least amount of radiation exposure to the child. We believe this provides an opportunity for PTC performance improvement by facilitating the transfer of images and educating referring facilities about indications for CT scans, dosage amounts, and radiation reduction protocols.
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