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Sustaining the gains: Reducing unnecessary computed tomography scans in pediatric trauma patients
Elaa Mahdi1, Nicole Toscano1, Lauren Pierson1
1Department of Surgery, University of Rochester Medical Center, Rochester, NY, 14642, United States.
Insights
Implementing imaging guidelines for pediatric blunt trauma significantly reduced unnecessary computed tomography (CT) scans. This initiative lowered radiation exposure and healthcare costs for children without compromising patient care.
Area of Science:
- Pediatric Trauma Care
- Radiology and Imaging
- Quality Improvement Science
Background:
- Unnecessary computed tomography (CT) scans in pediatric blunt trauma patients lead to increased radiation exposure and healthcare costs.
- Current practices often involve
- pan-scanning
- without clear clinical benefit or adherence to established guidelines.
- There is a need to optimize imaging protocols to ensure appropriate use of CT in evaluating injured children.
Purpose of the Study:
- To reduce the rate of non-indicated (NI) computed tomography (CT) scans in pediatric blunt trauma patients.
- To implement and evaluate the effectiveness of validated imaging guidelines in a pediatric trauma center.
- To decrease radiation exposure and associated healthcare costs in children with blunt traumatic injuries.
Main Methods:
- A prospective implementation of validated imaging guidelines for children under 16 with blunt trauma.
- Exclusion criteria included suspected physical abuse, prior CT imaging, penetrating mechanism, and instability.
- Comparison of CT scanning rates and guideline compliance between pre-implementation and post-implementation periods (July 2017–August 2021).
Main Results:
- The rate of non-indicated (NI) CT scans decreased from 51% to 25% post-implementation.
- Total CT scans per patient significantly declined (2.80 to 1.46, p<0.0001).
- Significant reductions in NI CTs across all regions (head, cervical spine, chest, abdomen/pelvis) led to an estimated saving of $218,000 in charges and spared 146 children from excessive radiation.
Conclusions:
- Quality improvement methodologies and implementation science can effectively reduce unnecessary CT scanning in pediatric blunt trauma.
- Adherence to imaging guidelines minimizes harmful radiation exposure in children without compromising clinical outcomes.
- This approach offers significant cost savings and resource optimization for healthcare systems treating pediatric trauma patients.
Background/Purpose:
"Pan-scanning" pediatric blunt trauma patients leads to exposure to harmful radiation and increased healthcare costs without improving outcomes. We aimed to reduce computed tomography (CT) scans that are not indicated (NI) by imaging guidelines for injured children.
Methods:
In July 2017, our Pediatric Trauma Center prospectively implemented validated imaging guidelines to direct CT imaging for trauma activations and consultations for children younger than 16 years old with blunt traumatic injuries. Patients with suspected physical abuse, CT imaging prior to arrival, penetrating mechanism, and instability precluding CT imaging were excluded. We compared CT scanning rates for pre-implementation (01/2016-06/2017) and post-implementation (07/2017-08/2021) time periods. Guideline compliance was evaluated by chart review and sustained through iterative process improvement cycles.
Results:
During the pre-implementation era, 61 patients underwent 171 CT scans of which 87 (51%) scans were not indicated by guidelines. Post-implementation, 363 patients had 531 scans and only 134 (25%) CTs were not indicated. Total CTs performed declined after initiation of guidelines (2.80 vs 1.46 scans/patient, p<0.0001). Total NI CTs declined (1.41 vs 0.37 NI scans/patient, p<0.0001) reflected in significant reductions in all anatomic regions: head, cervical spine, chest, and abdomen/pelvis. Charges related to NI scans decreased from $1,490.31/patient to $408.21/patient, saving $218,000 in charges. Based on prior utilization, 146 children were spared excessive radiation with no clinically significant missed injuries since guideline implementation.
Conclusions:
Quality improvement and implementation science methodologies to enhance compliance with imaging guidelines for children with blunt injuries can significantly reduce unnecessary CT scanning without compromising care. This practice reduces harmful radiation exposure in a sensitive patient population and may save healthcare systems money and resources.
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