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Computed tomography in the evaluation of pediatric trauma: We are still overdoing it!
Anastasia M Kahan1, Robert A Swendiman1, Matthew Eyre2
1Division of Pediatric Surgery, Department of Surgery, University of Utah School of Medicine, Salt Lake City, UT, USA.
Insights
Computed tomography (CT) imaging is frequently used for injured children in Utah. Compliance with Utah Pediatric Trauma Network (UPTN) guidelines was evaluated, revealing non-compliance for cervical spine, chest, and abdomen imaging.
Area of Science:
- Pediatric Emergency Medicine
- Radiology
- Trauma Surgery
Background:
- Established guidelines, such as those from the Pediatric Emergency Care Applied Research Network (PECARN), aim to optimize computed tomography (CT) imaging in injured children.
- The Utah Pediatric Trauma Network (UPTN) developed specific guidelines for imaging pediatric trauma patients at non-pediatric hospitals (non-PED1).
Purpose of the Study:
- To evaluate compliance with UPTN imaging guidelines in injured children treated at participating non-pediatric hospitals.
- To compare imaging practices at non-pediatric hospitals with pediatric trauma centers.
Main Methods:
- Retrospective review of the UPTN REDCap® database from January 2019 to December 2022.
- Analysis of CT imaging utilization in injured children based on UPTN guidelines.
Main Results:
- Of 5224 cases, 4162 (80%) underwent CT imaging, with 3275 (79%) at non-PED1 centers.
- Children at non-PED1 centers were older and less likely to have traumatic brain or orthopedic injuries.
- CT head imaging compliance was lower at non-PED1 centers (67%) compared to PED1 centers (87%).
- Non-compliance was highest for cervical spine, chest, and abdomen imaging.
Conclusions:
- Computed tomography (CT) imaging is widely used for evaluating injured children across Utah.
- Non-compliance with UPTN imaging guidelines was observed, particularly for cervical spine, chest, and abdominal imaging at non-pediatric facilities.
Background:
Many studies have attempted to define which injured children should undergo computed tomography (CT) imaging. Specifically, the Pediatric Emergency Care Applied Research Network (PECARN), a conglomerate of pediatric trauma centers, prospectively collected data on a large population of patients and have published multiple studies with recommendations on when to image based on the likelihood of a clinically important injury. Using these data and others, the Utah Pediatric Trauma Network (UPTN) created guidelines to help determine when imaging of injured children should be performed at our participating non-pediatric hospitals (non-PED1). The purpose of this study was to evaluate compliance to these guidelines.
Methods:
The UPTN REDCap® database was retrospectively reviewed between 1/2019-12/2022. An analysis of injured Utah children who underwent CT imaging based on UPTN guidelines was performed.
Results:
Of the 5224 cases reviewed, 4162 (80 %) underwent CT scan for evaluation, of which 3275 (79 %) received CT imaging at a non-PED1 center. Those treated at a non-PED1 hospital tended to be older (mean 10.2 v. 9.1 years, p = 0.002) and more likely to be ≥ 14 years (33 %v.28 %,p = 0.003). They were also less likely to have a traumatic brain injury (81 %v.91 %,p < 0.0001) or an orthopedic injury (14 %v.21 %,p < 0.0001). Children treated at non-PED1 hospitals were less likely to undergo a CT of the head (59 % v. 88 %,p < 0.0001) and abdomen (18 % v. 32 %,p < 0.0001), but more likely of the chest (17 %v.11 %,p = 0.01) or a pan scan (13 %v.8 %,p = 0.001). Compliance to guidelines was lower compared to the PED1 center for CT of the head (67 %v.87 %,p < 0.0001). Overall, compliance increased in the later years of the study for cervical spine and abdomen/pelvis (p = 0.0002,p < 0.0001 respectively), and decreased for head (p = 0.001).
Conclusions:
Across Utah, CT imaging is highly utilized in the evaluation of injured children. Non-compliance to imaging guidelines was found to be highest for imaging of the cervical-spine, chest, and abdomen.
Study Type/Level Of Evidence:
Level III, Prognostic/epidemiological.
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