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Computed Tomography Scan Utilization in Pediatric Trauma: Impact on Length of Stay and Incidence of False Positive
Mary J Edwards1, Timothy Jenkel2, Brandon Weller2
1From the Department of Surgery, Albany Medical College, Albany, NY.
Insights
Liberal use of computerized tomography (CT) scans in pediatric trauma did not shorten hospital stays. Extensive CT imaging, particularly of the cervical spine and chest, may lead to unnecessary false positives and longer stays.
Area of Science:
- Pediatric Radiology
- Trauma Imaging
- Diagnostic Imaging
Background:
- Computerized tomography (CT) scans are essential for diagnosing blunt trauma in children.
- Increased CT utilization in pediatric trauma raises concerns about radiation exposure.
- The impact of liberal CT imaging on length of stay and clinical outcomes requires investigation.
Purpose of the Study:
- To evaluate the association between liberal CT imaging practices and length of hospital stay in pediatric trauma patients.
- To determine the false-positive rates of CT scans in various body regions for pediatric trauma.
- To assess the clinical impact of liberal CT scanning on patient outcomes.
Main Methods:
- Retrospective review of medical records from a pediatric trauma center over 2 years.
- Data collected included CT scan utilization, length of stay, age, and Injury Severity Score (ISS).
- Rates of clinically significant and false-positive findings were analyzed for different CT scan regions.
Main Results:
- 58% of 735 pediatric trauma patients underwent CT scans, averaging 2.4 studies per patient.
- Clinically significant findings varied by region (e.g., 20% head, 14.7% abdomen).
- Liberal CT scanning did not decrease length of stay; >4 CTs correlated with longer stays.
Conclusions:
- False-positive rates for CT scans in pediatric trauma were generally low.
- High false-positive rates relative to true findings were noted for cervical spine and chest CTs.
- Liberal CT utilization did not expedite discharge and was linked to extended hospital stays.
Introduction:
Computerized tomography (CT) scans are the mainstay of diagnostic imaging in blunt trauma. Particularly in pediatric trauma, utilization of CT scans has increased exponentially in recent years. Concerns regarding radiation exposure to this vulnerable population have resulted in increased scrutiny of practice. What is not known is if liberal imaging practices decrease length of stay by eliminating the need for clinical observation, and the impact of false-positive rates from liberal use of CT scanning on clinical outcomes.
Methods:
Medical records from a nonaccredited pediatric trauma center with a practice of liberal imaging were reviewed over a 2-year period. Total CT scans obtained were recorded, in addition to length of stay, age, and Injury Severity Score (ISS). Rates of clinically significant imaging findings were recorded, as were false positive findings and complications of imaging.
Results:
Out of 735 children, 58% underwent CT scanning, and if scanned, received an average of 2.4 studies. Clinically significant findings were documented in 20% of head CTs, 2% of cervical spine CTs, 3.5% of chest CTs, 24% of facial CTs, and 14.7% of abdominal CTs. False-positive findings were found in 1.5% of head CTs, 1.2% of cervical spine CTs, 2.4% of chest CTs, and 2.5% of abdominal CTs. Liberal CT scanning was not associated with decreased length of stay. In contrast, obtaining CT scans on more than 4 body regions was independently predictive of longer length of stay, independent of ISS.
Conclusions:
False-positive rates of CT scans for trauma were low in this cohort. However, when scanning the cervical spine or the chest, for every 2 clinically significant findings obtained, there was at least one false positive result, calling into question the practice of liberal imaging of these regions. Liberal utilization of CT scan did not allow for more rapid discharge home, and for more than 4 CTs was independently associated with longer hospital stay.
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