Development and Implementation of a Pilot Radiation Reduction Protocol for Pediatric Head Injury

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.