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Paediatric trauma imaging in a regional Queensland hospital: Do we need clearer guidance?
Rohan Lynham1, Sarah Boxall2, Jacelle Warren3
1Anaesthesia Department, Whangarei Hospital, Whangarei, New Zealand.
Insights
Adherence to computed tomography (CT) scan guidelines in paediatric trauma care is suboptimal, with only 56.3% compliance. Improving CT ordering practices and multidisciplinary team involvement is crucial for reducing radiation exposure in children.
Area of Science:
- Medical Imaging
- Paediatric Radiology
- Trauma Care
Background:
- Paediatric trauma presents unique challenges in care due to anatomical and physiological differences.
- Radiation exposure from medical imaging, especially computed tomography (CT), requires careful consideration in children.
- Current CT scan ordering practices in paediatric trauma may not align with established guidelines.
Purpose of the Study:
- To compare current CT scan ordering practices for paediatric trauma patients at a regional Australian hospital with UK consensus guidelines.
- To assess compliance rates with evidence-based paediatric trauma imaging protocols.
- To identify areas for improvement in CT scan utilization for paediatric trauma.
Main Methods:
- A retrospective audit of 71 paediatric trauma CT scans ordered from the Emergency Department (ED) between May 2017 and May 2018.
- Review of CT scan ordering details to determine compliance with Royal College of Radiologists Paediatric trauma protocols.
- Descriptive statistics and chi-squared tests were used to compare compliant and non-compliant cases.
Main Results:
- Overall compliance with paediatric trauma CT imaging guidelines was 56.3%.
- Lowest compliance was observed for CT neck imaging (14%).
- Initiating a trauma call was associated with increased use of full-body scans, while paediatric team involvement correlated with improved compliance.
Conclusions:
- Evidence-based guidelines are essential for minimizing radiation exposure in paediatric trauma patients undergoing CT scans.
- Current CT scan ordering practices in paediatric trauma demonstrate a need for improvement.
- Multidisciplinary team involvement in decision-making can enhance compliance and optimize imaging protocols.
Objective:
Paediatric trauma is a major cause of morbidity and mortality in those aged 0-14. Anatomical and physiological differences require a specialised approach to paediatric trauma care. Medical imaging, particularly computed tomography (CT) scans, requires specific consideration because of the consequences of radiation exposure in the paediatric population. The present study compares current practice of CT scan ordering in paediatric trauma patients at a regional Australian hospital against consensus guidelines published in the UK.
Methods:
A retrospective audit of paediatric trauma CT scans referred from the ED from May 2017 to May 2018 was completed. Details relating to CT scan ordering were reviewed and compliance with the Royal College of Radiologists Paediatric trauma protocols, was determined. Descriptive statistics and χ2 tests comparing those that met and did not meet guidelines were performed.
Results:
A total of 71 CT scans were included with an overall compliance rate of 56.3%. Specific regional compliance was lowest with CT neck at 14%. Patients where a trauma call was initiated were more likely to receive a full body (pan) scan rather than region specific imaging. Compliance improved when paediatric team involvement was documented.
Conclusions:
Evidence-based guidelines for CT imaging in paediatric trauma are essential to reduce unnecessary radiation exposure for children. The present study has demonstrated that current practice has the potential to be improved and that decisions should involve a multidisciplinary team.
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