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Development and Implementation of a Pilot Radiation Reduction Protocol for Pediatric Head Injury
Rachel Appelbaum1, Travis Hoover1, Sarah Azari1
1Lehigh Valley Health Network, Allentown, Pennsylvania.
Insights
A new guideline reduced repeat head CT scans in pediatric head injury patients, significantly lowering radiation exposure. This approach ensures necessary imaging while minimizing risks associated with radiation in children.
Area of Science:
- Pediatric Traumatology
- Radiology
- Medical Imaging Guidelines
Background:
- Traumatic brain injury (TBI) is a primary cause of pediatric morbidity and mortality in the U.S.
- Current imaging practices for pediatric head injuries may lead to excessive radiation exposure.
- There is a need for guidelines to optimize imaging protocols and reduce radiation risks.
Purpose of the Study:
- To develop and implement an evidence-based guideline for imaging pediatric head injury patients.
- To identify criteria for repeat imaging in pediatric head trauma.
- To establish rapid brain protocol magnetic resonance imaging (MRI) as a first-line modality.
Main Methods:
- Retrospective chart review of pediatric trauma patients (0-14 years) from January 2013 to June 2019.
- Guideline implementation focused on repeat scan appropriateness based on Glasgow Coma Scale (GCS) and initial CT findings.
- Comparison of imaging utilization before and after guideline implementation.
Main Results:
- A significant decrease in repeat head CT scans from 34.5% to 6.3% (P < 0.02) post-guideline.
- Reduced mean head CTs per patient from 1.63 to 1.06 (P < 0.02).
- The guideline effectively identified patients requiring repeat imaging while reducing overall exposure.
Conclusions:
- Head CT is crucial for initial pediatric trauma evaluation but can be overused.
- Implementing imaging guidelines based on clinical criteria can effectively reduce radiation exposure.
- This approach minimizes long-term radiation risks in pediatric patients without compromising injury detection.
Background:
Traumatic brain injury is the leading cause of morbidity and mortality for children in the United States. The aim of this study was to develop and implement a guideline to reduce radiation exposure in the pediatric head injury patient by identifying the patient population where repeat imaging is necessary and to establish rapid brain protocol magnetic resonance imaging as the first-line modality.
Methods:
A retrospective chart review of trauma patients between 0 and 14 y of age admitted at a pediatric level 2 trauma center was performed between January 2013 and June 2019. The guideline established the appropriateness of repeat scans for patients with Glasgow Coma Scale >13 with clinical neurological deterioration or patients with Glasgow Coma Scale ≤13 and intracranial hemorrhagic lesion on initial head computed tomography (CT).
Results:
Our trauma registry included 592 patients during the study period, 415 before implementation and 161 after implementation. A total of 132 patients met inclusion criteria, 116 pre-guideline and 16 post-guideline. The number of patients receiving repeat head CTs significantly decreased from 34.5% to 6.3% (P < 0.02). There was also a significant decrease in the mean number of head CT/patient pre-guideline 1.63 (range 1-7) compared with post-guideline 1.06 (range 1-2) (P < 0.02).
Conclusions:
CT head imaging is invaluable in the initial trauma evaluation of pediatric patients. However, it can be overused, and the radiation may lead to long-term deleterious effects. Establishing a head imaging guideline which limits use with clinical criteria can be effective in reducing radiation exposure without missing injuries.
