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An evidence-based algorithm decreases computed tomography use in hemodynamically stable pediatric blunt abdominal
Osayi A Odia1, Brian Yorkgitis2, Lori Gurien2
1Department of Emergency Medicine, Division of Pediatric Emergency Medicine, University of Florida College of Medicine - Jacksonville, 655 W 8th St., Jacksonville, FL, 32209, USA.
American Journal of Surgery
|January 15, 2020
Summary
An evidence-based algorithm reduced abdominopelvic-computed tomography (CTAP) scans by 27% in pediatric blunt abdominal trauma (BAT) patients. This approach safely decreased CTAP use without increasing hospital resource utilization.
Area of Science:
- Pediatric Trauma Surgery
- Radiology and Imaging
- Evidence-Based Medicine
Background:
- Concerns exist regarding the overuse of abdominopelvic-computed tomography (CTAP) in pediatric blunt abdominal trauma (BAT) due to malignancy risks.
- Evaluating the impact of evidence-based guidelines on imaging practices is crucial for optimizing patient care.
- Hemodynamically stable children with BAT are a specific population where judicious CTAP use is being investigated.
Purpose of the Study:
- To assess the effectiveness of an evidence-based algorithm in reducing CTAP utilization for pediatric BAT.
- To evaluate the impact of the algorithm on hospital resource use, including emergency department length of stay.
- To determine if the reduction in CTAP scans led to any missed injuries in the studied pediatric population.
Main Methods:
- Retrospective cohort study comparing patients one year before and after algorithm implementation.
- Inclusion criteria: Hemodynamically stable pediatric patients (≤14 years) with BAT treated at a Level I pediatric trauma center.
- Primary outcome: Comparison of CTAP rates; secondary outcomes: missed injuries and emergency department length of stay (LOS).
Main Results:
- CTAP rates decreased by 27% (p=0.02) after algorithm implementation (50 patients post- vs. 65 pre-algorithm).
- Odds of receiving a CTAP were significantly lower post-implementation (OR 0.3, 95% CI 0.1-0.6).
- No significant missed injuries were identified in the post-algorithm cohort, and emergency department LOS decreased by 53 minutes (p=0.03).
Conclusions:
- An evidence-based algorithm can safely and effectively decrease the utilization of CTAP in pediatric blunt abdominal trauma.
- The implemented algorithm did not lead to an increase in hospital resource utilization.
- This approach represents a successful strategy for optimizing imaging practices in pediatric trauma care.
