Implementation of a CT scan practice guideline for pediatric trauma patients reduces unnecessary scans without impacting outcomes

McGrew, Patrick; Chestovich, Paul J; Fisher, Jay D.; Kuhls, Deborah A.; Fraser, Douglas R.; Patel, Palak; Katona, Chad W.; Saquib, Syed; Fildes, John

doi:10.1097/ta.0000000000001974

Cited by 27 publications

(20 citation statements)

References 18 publications

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“…Among studies targeting several imaging modalities or diagnoses, 74–79% of the studies showed a reduction in use of low-value imaging. In contrast, studies targeting one specific modality only showed that targeting X-ray [ 37 , 47 , 48 , 63 , 64 , 83 , 86 , 90 , 92 , 98 , 104 , 112 , 119 , 124 , 130 ], CT [ 41 , 46 , 49 , 53 , 54 , 58 , 60 , 62 , 67 , 69 , 70 , 77 , 79 , 82 , 87 , 88 , 94 – 96 , 101 , 102 , 106 , 108 , 121 – 123 , 125 – 127 , 129 ] or MRI [ 45 , 68 , 75 , 105 , 118 ] led to a 87, 86, and 83% reduction in low-value imaging, respectively. Few studies included other imaging modalities.…”

Section: Resultsmentioning

confidence: 99%

Interventions to reduce low-value imaging – a systematic review of interventions and outcomes

Kjelle

Andersen

Soril

et al. 2021

BMC Health Serv Res

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Background It is estimated that 20–50% of all radiological examinations are of low value. Many attempts have been made to reduce the use of low-value imaging. However, the comparative effectiveness of interventions to reduce low-value imaging is unclear. Thus, the objective of this systematic review was to provide an overview and evaluate the outcomes of interventions aimed at reducing low-value imaging. Methods An electronic database search was completed in Medline – Ovid, Embase-Ovid, Scopus, and Cochrane Library for citations between 2010 and 2020. The search was built from medical subject headings for Diagnostic imaging/Radiology, Health service misuse or medical overuse, and Health planning. Keywords were used for the concept of reduction and avoidance. Reference lists of included articles were also hand-searched for relevant citations. Only articles written in English, German, Danish, Norwegian, Dutch, and Swedish were included. The Mixed Methods Appraisal Tool was used to appraise the quality of the included articles. A narrative synthesis of the final included articles was completed. Results The search identified 15,659 records. After abstract and full-text screening, 95 studies of varying quality were included in the final analysis, containing 45 studies found through hand-searching techniques. Both controlled and uncontrolled before-and-after studies, time series, chart reviews, and cohort studies were included. Most interventions were aimed at referring physicians. Clinical practice guidelines (n = 28) and education (n = 28) were most commonly evaluated interventions, either alone or in combination with other components. Multi-component interventions were often more effective than single-component interventions showing a reduction in the use of low-value imaging in 94 and 74% of the studies, respectively. The most addressed types of imaging were musculoskeletal (n = 26), neurological (n = 23) and vascular (n = 16) imaging. Seventy-seven studies reported reduced low-value imaging, while 3 studies reported an increase. Conclusions Multi-component interventions that include education were often more effective than single-component interventions. The contextual and cultural factors in the health care systems seem to be vital for successful reduction of low-value imaging. Further research should focus on assessing the impact of the context in interventions reducing low-value imaging and how interventions can be adapted to different contexts.

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Section: Resultsmentioning

confidence: 99%

Interventions to reduce low-value imaging – a systematic review of interventions and outcomes

Kjelle

Andersen

Soril

et al. 2021

BMC Health Serv Res

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“…The topic of CT efficacy for the evaluation of injuries in trauma patients is highly debated in the literature [3,[6][7][8][17][18][19]. Although several efforts have previously been made to implement judicious use of diagnostic algorithms and CT imaging in emergency and trauma settings [18][19][20][21][22][23], indiscriminate CT imaging as a screening measure, especially for low impact injuries, may pose a challenge for already strained healthcare infrastructures [17,[24][25]. Uniform CT scans in trauma patients with normal vitals may delay diagnosis and treatment for other patients with non-traumatic but serious illnesses.…”

Section: Discussionmentioning

confidence: 99%

Is There a Need for Abdominal CT Scan in Trauma Patients With a Low-Risk Mechanism of Injury and Normal Vital Signs?

Ledrick¹,

Payvandi²,

Murray³

et al. 2020

Cureus

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Background Clinically significant injuries are often missed in trauma patients with low-risk mechanisms of injury and lack of "red flags," such as abnormal vital signs. The purpose of this retrospective analysis was to evaluate the efficacy of computed axial tomography (CT) for identifying occult injuries in a high-volume trauma center. Methods Records from our institutional trauma registry were retrospectively extracted, examining encounters from January 2015 to October 2019. Those patients between the ages of 18 and 65 who were referred to the trauma team with a CT scan of the abdomen and had low-risk mechanisms of injury, a Glasgow Coma Scale (GCS) score of 15, and normal vital signs at presentation were included. Patients in the lowest trauma categorization (Level Three, Consult) met the study definition for the low-risk mechanism of injury. Demographic and clinical data were abstracted for all patients. For this analysis, patients were divided into two groups based on age (18-40 years or 40-65 years). Injuries found on CT, their clinical significance, and the likelihood of being missed without CT were determined. Results Of 2,103 blunt trauma patients that received a CT scan of the abdomen from January 2015 to October 2019, 134/2,103 (6.4%) met the inclusion criteria (mean age: 44.6 years; 72.3% male). Patients between the ages of 40 and 65 years comprised 61.2% (82/134) of the study population. Of the included patients, 17.2% (23/134) had at least one acute traumatic injury identified after CT imaging of the torso. Occult injuries found on CT included rib fracture with associated lung injuries (10/23, 43.5%), splenic laceration (4/23, 17.4%), liver laceration (3/23, 13.0%), gluteal hematoma with active bleeding (1/23, 4.3%), sternal fractures (3/23, 13.0%), and thoracic or lumbar spine fractures (2/23, 8.7%). An independent review of the medical records determined that 9.0% (12/134) of these patients had traumatic injuries that would have been missed based on clinical examination without CT. Conclusions Based on our experience, utilizing CT imaging of at least the abdomen as a routine screening measure for all trauma consults-even low-risk patients with normal vital signs-can rapidly and accurately identify clinically significant injuries that would have been otherwise missed in a notable portion of the population.

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“…Conventional abdominal ultrasound is considered the best choice for the follow-up of these patients, although there is no consensus about the time and impact on the evolution. On the other hand, some series report the absence of complications in the follow-up of these patients, reaching figures of up to 87% without requiring radiological studies, regardless of the degree of injury [11,12,15,16].…”

Section: Discussionmentioning

confidence: 99%

Blunt Liver Trauma in a Pediatric Patient

Carlos¹,

Bianchi

Nuria

et al. 2021

BJSTR

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Objective: Nowadays the conservative treatment in case of solid organ injury in abdominal trauma is the procedure of choice, regardless of the injury degree. Our objective is to describe our abdominal trauma protocol in case of a solid organ injury and present a case of a pediatric patient with liver organ injury after an abdominal trauma.Case Report: A 13-year-old-patient was transfer to our center with a liver injury after blunting abdominal trauma. Demographic data, trauma mechanism, organ, associated lesions, examination made at diagnosis and follow-up, type of treatment, success rate of treatment, complications during admission and after discharge were collected. Conclusion:The gold standard for the initial treatment of abdominal trauma with solid organ injury, regardless of the degree of involvement, is the conservative treatment.

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Implementation of a CT scan practice guideline for pediatric trauma patients reduces unnecessary scans without impacting outcomes

Abstract: Therapeutic study, level IV.

Cited by 27 publications

References 18 publications

Interventions to reduce low-value imaging – a systematic review of interventions and outcomes

Interventions to reduce low-value imaging – a systematic review of interventions and outcomes

Is There a Need for Abdominal CT Scan in Trauma Patients With a Low-Risk Mechanism of Injury and Normal Vital Signs?

Blunt Liver Trauma in a Pediatric Patient

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