Computed Tomography Scan Utilization in Pediatric Trauma

Abstract

Introduction: Computerized tomography (CT) scans are the mainstay of diagnostic imaging in blunt trauma. Particularly in pediatric trauma, utilization of CT scans has increased exponentially in recent years. Concerns regarding radiation exposure to this vulnerable population have resulted in increased scrutiny of practice. What is not known is if liberal imaging practices decrease length of stay by eliminating the need for clinical observation, and the impact of false-positive rates from liberal use of CT scanning on clinical outcomes.Methods: Medical records from a nonaccredited pediatric trauma center with a practice of liberal imaging were reviewed over a 2-year period. Total CT scans obtained were recorded, in addition to length of stay, age, and Injury Severity Score (ISS). Rates of clinically significant imaging findings were recorded, as were false positive findings and complications of imaging.Results: Out of 735 children, 58% underwent CT scanning, and if scanned, received an average of 2.4 studies. Clinically significant findings were documented in 20% of head CTs, 2% of cervical spine CTs, 3.5% of chest CTs, 24% of facial CTs, and 14.7% of abdominal CTs. False-positive findings were found in 1.5% of head CTs, 1.2% of cervical spine CTs, 2.4% of chest CTs, and 2.5% of abdominal CTs. Liberal CT scanning was not associated with decreased length of stay. In contrast, obtaining CT scans on more than 4 body regions was independently predictive of longer length of stay, independent of ISS.Conclusions: False-positive rates of CT scans for trauma were low in this cohort. However, when scanning the cervical spine or the chest, for every 2 clinically significant findings obtained, there was at least one false positive result, calling into question the practice of liberal imaging of these regions. Liberal utilization of CT scan did not allow for more rapid discharge home, and for more than 4 CTs was independently associated with longer hospital stay.

Optimising whole body computed tomography doses for paediatric trauma patients: a Swiss retrospective analysis

“…Acquiring plain films in a busy trauma bay is a challenge, even for very skilled radiology technicians. This could translate into a higher probability in the use of CT at non-level-1 PTCs and adult trauma centres [13,[36][37][38]. In addition to higher EDs at adult facilities [18,39,40], this combination may increase the risk of exposing children to unnecessary radiation.…”

“…Although reports about adult cohorts suggest that the mechanism of injury alone should not be an indication for using WBCT [7,33,41]. Judicious use of CT is of high importance and as with any test, the possibility of a false positive result must be considered [38].…”