Safely reducing abdominal/pelvic computed tomography imaging in pediatric trauma: a quality improvement initiative
Suzanne Beno1, Felicia Paluck2, Talia Greenspoon2
1Department of Paediatrics, Hospital for Sick Children, University of Toronto, Toronto, ON, Canada. suzanne.beno@sickkids.ca.
Insights
A quality improvement initiative successfully reduced computed tomography (CT) scans for children with low risk of intra-abdominal injury. This initiative decreased unnecessary CT imaging without compromising patient safety or missing critical injuries.
Area of Science:
- Pediatric Trauma Care
- Radiology Quality Improvement
- Clinical Decision Support
Background:
- Intra-abdominal injury is a rare but life-threatening complication in pediatric trauma.
- Computed tomography (CT) is frequently used in pediatric trauma evaluations, even in low-risk cases.
- Reducing unnecessary CT imaging is crucial to minimize radiation exposure and healthcare costs in children.
Purpose of the Study:
- To decrease the rate of abdominal/pelvic CT scans in pediatric trauma patients at very low risk for intra-abdominal injury.
- To implement and evaluate a quality improvement initiative focused on optimizing CT utilization.
- To ensure patient safety is maintained while reducing imaging rates.
Main Methods:
- A quality improvement initiative was implemented using the Model for Improvement in children aged 0-15.99 years.
- Interventions included clinical decision support, institutional education, and audit and feedback.
- Statistical process control was used to monitor abdominal/pelvic CT rates and balancing measures over time.
Main Results:
- The rate of abdominal/pelvic CT scans in low-risk pediatric trauma patients decreased from 26.8% to 6.8% after the intervention.
- This represents an absolute reduction of 20.0% (p < 0.05), with a statistically significant decrease in imaging rates.
- No clinically significant intra-abdominal injuries were missed during the intervention period.
Conclusions:
- A quality improvement initiative effectively reduced unnecessary abdominal/pelvic CT scans in low-risk pediatric trauma patients.
- Standardized decision tools can be leveraged to decrease CT utilization without compromising patient care.
- This approach successfully minimized radiation exposure and healthcare costs while maintaining high standards of care.
Objective:
Intra-abdominal injury occurs in less than 15% of pediatric trauma activations but can be life-threatening. Computed tomography (CT) imaging is commonly ordered in pediatric trauma, even when intra-abdominal injury risk is low. We aimed to reduce abdominal/pelvic CT rates in children at very low risk for intra-abdominal injury requiring trauma activation at our pediatric trauma centre.
Methods:
We implemented a quality improvement initiative using the Model for Improvement in children 0-15.99 years of age who activated a trauma response and were evaluated for intra-abdominal injury. Interventions included clinical decision support, institutional education, and individual audit and feedback. Our primary outcome was abdominal/pelvic CT rate in patients at very low risk for intra-abdominal injury. Balancing measures included CT scans ordered within 24 h of emergency department (ED) assessment and return to ED or hospitalization within 72 h for missed intra-abdominal injury. Statistical process control was used to evaluate rates over time.
Results:
The baseline period (April 1, 2016 - November 30, 2017) included 359 trauma patients with a CT rate of 26.8% (95% CI 20.5-33.8%) in those at low risk for intra-abdominal injury. The intervention period (Dec 1, 2017-Dec 31, 2019) included 445 patients with a CT rate in low-risk patients of 6.8% (95% CI 3.2-12.6%), demonstrating an absolute reduction of 20.0% (95% CI 12.2-27.7%, p < 0.05). Interventions resulted in a significant decrease in abdominal/pelvic CT imaging corresponding with special cause variation. No clinically significant intra-abdominal injuries were missed.
Conclusions:
This quality improvement initiative reduced abdominal/pelvic CT rates in pediatric trauma patients at low risk for intra-abdominal injury without any missed cases of significant injury. Leveraging standardized decision tools to reduce unnecessary CT imaging can be successfully accomplished without compromising care.
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