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Are We Imaging Gently in Indiana? A System-Wide Population-Based Study of Chest CT Use in the Pediatric Trauma
Sindhu Mannava1, Amelia Collings1, Cameron Colgate2
1From the Department of Surgery.
Insights
Pediatric trauma centers increasingly use chest CT scans, contrary to radiation reduction goals. This study found trauma centers performed more chest CTs before chest X-rays, even without thoracic injuries.
Area of Science:
- Medical Imaging
- Pediatric Trauma Care
- Radiation Safety
Background:
- Efforts to reduce radiation exposure in pediatric trauma patients have been ongoing for a decade.
- This study investigates whether trauma centers (TCs) and non-trauma centers (non-TCs) align with these radiation reduction efforts.
Purpose of the Study:
- To determine if TCs and non-TCs are decreasing chest computed tomography (CT) use in pediatric trauma patients.
- To compare chest CT and chest radiograph (CXR) utilization and thoracic injury incidence between TCs and non-TCs.
Main Methods:
- A state-wide database from 2010-2020 was queried for pediatric trauma encounters.
- Chest CTs and CXRs were analyzed, along with injury diagnosis codes.
- Chest CT use and thoracic injury incidence were compared between TCs and non-TCs, excluding transfer encounters.
Main Results:
- Chest CT use increased annually at both TCs and non-TCs during the study period.
- TCs performed chest CT before CXR more frequently than non-TCs (0.4% vs 0.1%).
- Chest CT was performed in 4.5% of non-injured cases at TCs versus 5.2% at non-TCs.
Conclusions:
- Trauma encounters in the study showed increased chest CT utilization at both TCs and non-TCs.
- TCs demonstrated a higher frequency of chest CT use prior to CXR.
- Reinforcing conservative CT imaging principles through multidisciplinary education is recommended for TCs.
Objectives:
Over the past decade, there has been a significant effort to decrease radiation exposure in pediatric trauma patients. The objective of this study was to determine if trauma centers (TCs) and nontrauma centers (non-TCs) are practicing in line with this effort. We hypothesized that TCs would demonstrate a significant decrease in the use of chest computed tomography (CT) during the study period, whereas non-TC would show no change in chest CT use.
Methods:
We queried a state-wide database from 2010 to 2020 for pediatric trauma encounters at TCs and non-TCs within a single large health system. All transfer encounters were excluded. Chest CTs and chest radiographs (CXRs) were performed, and injury diagnosis codes were extracted for each encounter. Chest CT use and incidence of thoracic injuries were compared between TCs and non-TCs.
Results:
A total of 13,014 encounters were included, of which 85.8% occurred at TCs and 14.2% occurred at non-TCs. There were significant differences between TC and non-TC encounter demographics. During the study period, the percentage of trauma encounters in which chest CT was obtained increased yearly at both TCs and non-TCs. Among encounters where both modalities were performed in the first 24 hours, chest CT was performed before CXR in 0.4% of TC and 0.1% of non-TC encounters ( P = 0.086). Among encounters without thoracic injury, chest CT was performed in 5.2% of cases at non-TCs and 4.5% of cases at TCs ( P < 0.001).
Conclusions:
In the trauma encounters studied, chest CT was performed prior to CXR more frequently at TCs compared to non-TCs. These data may reflect regional trauma triage protocols, availability of chest CT, or differences in education between institutions. Whereas TCs may see more severely injured patients more frequently, education regarding conservative CT imaging principles should be reinforced through multidisciplinary efforts.
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