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Implementation of clinical effectiveness guidelines for solid organ injury after trauma: 10-year experience at a
Christine M Leeper1, Isam Nasr2, Abigail Koff3
1Division of General Surgery and Trauma, Department of Surgery, University of Pittsburgh Medical Center. 200 Lothrop Street, Pittsburgh, PA 15213, USA; Children's Hospital of Pittsburgh of UPMC. 7th Floor, Faculty Pavilion, One Children's Hospital Drive, 4401 Penn Avenue, Pittsburgh, PA 15224, USA.
Insights
Implementing imaging guidelines for pediatric blunt abdominal trauma reduced CT scans for low-grade injuries. This approach safely managed high-grade injuries, decreasing childhood radiation exposure without compromising patient outcomes.
Area of Science:
- Pediatric Radiology
- Trauma Imaging
- Radiation Safety
Background:
- Diagnostic imaging for pediatric blunt abdominal trauma is adapting to concerns about radiation exposure.
- Imaging guidelines aim to reduce computed tomography (CT) scans while ensuring detection of significant injuries.
Purpose of the Study:
- To evaluate the impact of implementing imaging guidelines on CT scan utilization and injury detection in pediatric blunt abdominal trauma.
- To assess if guideline implementation reduced CT scans without compromising the diagnosis of clinically significant injuries.
Main Methods:
- Retrospective review of pediatric patients (0-17 years) with solid organ injury who underwent CT scans from 2005-2014.
- Analysis of annual trauma admissions, CT scans, demographics, injury characteristics, and procedures.
- Statistical analysis including Fisher exact and rank sum tests (p<0.05 significance).
- Study design: Level III, retrospective.
Main Results:
- A significant decrease in the overall percentage of abdominal CT scans was observed post-guideline implementation.
- The median percentage of low-grade solid organ injuries decreased significantly (1.3% to 0.6%).
- No significant difference was found in high-grade injuries (1.3% to 1.1%).
- No deaths, readmissions, or delayed diagnoses requiring intervention occurred.
Conclusions:
- Imaging guidelines effectively reduced low-grade solid organ injury diagnoses in pediatric blunt abdominal trauma.
- The guidelines did not impede the diagnosis or management of high-grade injuries.
- Selective imaging decreases radiation exposure in children and does not lead to adverse outcomes like delayed bleeding or death.
Background:
Diagnostic imaging of pediatric blunt abdominal trauma is evolving in light of increased attention to radiation exposure. We hypothesize that the implementation of imaging guidelines has reduced total CT scans without missing clinically significant injury.
Methods:
We retrospectively reviewed blunt trauma patients age 0-17 with solid organ injury who underwent CT scan at our academic level 1 pediatric trauma center between 2005 and 2014. Variables including total annual trauma admissions and CT scans, demographics, injury characteristics, and procedures were recorded. Descriptive statistics, Fisher exact and rank sum testing were performed. p<0.05 defined significance.
Results:
Overall percentage of abdominal CT scans decreased significantly after protocol implementation. There were 498 solid organ injuries in 403 subjects. There was a significant decrease in the median percentage of low grade injuries (1.3% versus 0.6%; p=0.019) but no difference in high grade injuries (1.3% versus 1.1%; p=0.394). No patient had death, readmission or delayed diagnosis of injury requiring intervention.
Conclusion:
Implementation of imaging guidelines for blunt abdominal trauma decreased the incidence of low grade solid organ injuries at our institution, but did not inhibit diagnosis and safe management of high grade injuries. Selective imaging of trauma patients decreases childhood radiation exposure and does not result in delayed bleeding or death.
Level Of Evidence:
Level III, retrospective study.
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