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Implementation of a CT scan practice guideline for pediatric trauma patients reduces unnecessary scans without
Patrick R McGrew1, Paul J Chestovich, Jay D Fisher
1From the Department of Surgery, Division of Acute Care Surgery, University of Nevada, Las Vegas School of Medicine, Las Vegas, Nevada.
Insights
Implementing CT scan guidelines for pediatric trauma patients significantly reduced imaging use and radiation exposure without impacting patient outcomes. These guidelines are crucial for minimizing unnecessary CT scans in children.
Area of Science:
- Pediatric Trauma Care
- Medical Imaging Guidelines
- Radiation Safety in Children
Background:
- Computed tomography (CT) scans are vital for evaluating pediatric trauma but carry risks associated with ionizing radiation.
- Recent studies highlight the importance of CT scan guidelines in managing pediatric trauma cases.
- This study reviews CT utilization in pediatric blunt trauma before and after guideline implementation.
Purpose of the Study:
- To evaluate the impact of a CT scan practice guideline on imaging use in pediatric blunt trauma patients.
- To assess changes in CT scan rates and positive scan findings post-guideline implementation.
- To determine if guideline implementation affected patient outcomes such as length of stay, readmissions, or mortality.
Main Methods:
- A Pediatric Level 2 Trauma Center implemented a CT scan guideline in March 2014, based on established criteria.
- A retrospective review of pediatric trauma patients (age < 15) was conducted from 2010 to 2016, comparing pre- and post-guideline periods.
- Data included CT scans of the head, chest, and abdomen/pelvis, excluding penetrating injuries and in-hospital scans. Statistical analysis used chi-squared and Wilcoxon rank-sum tests.
Main Results:
- A total of 1,934 patients were analyzed (1,106 pre-guideline, 828 post-guideline).
- Significant reductions in CT scans were observed: 17.7% for head, 11.5% for chest, and 18.8% for abdomen/pelvis (p < 0.001).
- While head CT positivity remained similar, chest and abdomen CT positivity increased post-implementation. Secondary outcomes were not significantly altered.
Conclusions:
- Adoption of a pediatric CT guideline effectively decreases CT scan utilization, thereby reducing radiation exposure in children.
- The implementation of these guidelines did not negatively affect patient outcomes.
- Trauma centers should consider adopting similar guidelines to reduce unnecessary CT imaging in pediatric trauma patients.
Introduction:
Computed tomography (CT) scans are useful in the evaluation of trauma patients, but are costly and pose risks from ionizing radiation in children. Recent literature has demonstrated the use of CT scan guidelines in the management of pediatric trauma. The study objective is to review our treatment of pediatric blunt trauma patients and evaluate CT use before and after CT-guideline implementation.
Methods:
Our Pediatric Level 2 Trauma Center (TC) implemented a CT scan practice guideline for pediatric trauma patients in March 2014. The guideline recommended for or against CT of the head and abdomen/pelvis using published criteria from the Pediatric Emergency Care and Research Network. There was no chest CT guideline. We reviewed all pediatric trauma patients for CT scans obtained during initial evaluation before and after guideline implementation, excluding inpatient scans. The Trauma Registry Database was queried to include all pediatric (age < 15) trauma patients seen in our TC from 2010 to 2016, excluding penetrating mechanism and deaths in the TC. Scans were considered positive if organ injury was detected. Primary outcome was the proportion of patients undergoing CT and percent positive CTs. Secondary outcomes were hospital length of stay, readmissions, and mortality. Categorical and continuous variables were analyzed with χ and Wilcoxon rank-sum tests, respectively. p < 0.05 was considered significant.
Results:
We identified 1,934 patients: 1,106 pre- and 828 post-guideline. Absolute reductions in head, chest, and abdomen/pelvis CT scans were 17.7%, 11.5%, and 18.8%, respectively (p < 0.001). Percent positive head CTs were equivalent, but percent positive chest and abdomen CT increased after implementation. Secondary outcomes were unchanged.
Conclusions:
Implementation of a pediatric CT guideline significantly decreases CT use, reducing the radiation exposure without a difference in outcome. Trauma centers treating pediatric patients should adopt similar guidelines to decrease unnecessary CT scans in children.
Level Of Evidence:
Therapeutic study, level IV.
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