Computed tomography before transfer to a level I pediatric trauma center risks duplication with associated increased radiation exposure

CT Utilization in Transferred Trauma Patients

“…Ultimately, it subjects patients to the clinical risk of a less monitored environment as well as general discomfort from multiple CT scans. Further, a small but real risk of malignancy associated with excess radiation from imaging has become a growing concern [5][6][7]. Ultimately, the decisions to image in trauma are predicated on balancing the risk of missing injuries with those of radiation exposure.…”

“…Appropriateness of repeated and additionally obtained radiographic studies is, however, recognized as a problem within our regional trauma system, the national system, and in developing and developed international systems [3,4]. Issues arising from CT scanning prior to transfer of a patient include duplication of studies, increased cost, increased radiation exposure to patients, possible increased radioactive dye exposure and contrast nephropathy, increased length of stay, and increased morbidity and mortality [5,6]. Additional CT scans obtained after transfer, even of body regions different than received prior to transfer, have the potential for delay in diagnosis, prolonged time to treatment, increased or overlapping radiation exposure, and discomfort of the patient.…”

Repeat abdominal computed tomography scans after pediatric blunt abdominal trauma: missed injuries, extra costs, and unnecessary radiation exposure

“…The rescan percentage for head CT scans was higher at 9.2%. Chawls et al [13] found that head CT scans were repeated in 28 (90%) of 31 previously scanned transfer patients. Chawls et al also found that 2 (33%) of 6 of children transferred to their center underwent repeat abdominal scanning after performance of an initial outside abdominal CT.…”

Prehospital and Early Clinical Care of Infants, Children, and Teenagers Compared to an Adult Cohort

“…However, CT imaging has become essential in the imaging evaluation of trauma patients and is being used with progressively increasing frequency [27,28], caused by the well documented benefit for the outcome of trauma patients [9,29,30]. Nevertheless, a byproduct of the increased use of CT has been the more frequent exposure of injured children to potentially harmful ionizing radiation [27]. Therefore, the lower rate of performed MSCT only in case of infants might be due to the possibility of performing a cranial ultrasound, if the ossification of the fonticulus is not completed.…”