Pediatric trauma care with computed tomography—criteria for CT scanning

Abstract

Trauma centers, trauma management concepts, as well as integration of whole-body computed tomography (CT) reduced mortality significantly. The accuracy of a trauma care algorithm with emergency CT in children was evaluated. Data of 71 children with emergency CT were recorded retrospectively. In addition to epidemiological data admission date, kind of CT scan, mechanism of injury, missed diagnoses, injury severity score (ISS), admission to and time on intensive care unit (ICU), and time of hospitalization were observed. The algorithm for CT scanning was based on mechanism of injury, pattern of injury, and altered vital signs. Sixty-nine percent of the children reached the ER during on-call service hours. A percentage of 32.4 received a whole-body scan and 67.6 % a cranial scan. The mean ER ISS was 9.9 points (1-57). Children have different trauma mechanisms compared to adults. A percentage of 33.8 of the children had relevant trauma related findings in the CT scan. In 2 children, (2.8 %) 3 diagnoses (2.2 %) were initially missed. After reevaluation of the CT data, all diagnoses were identified. Thus, the accuracy of our algorithm in children was 100 %. In children, our algorithm detected all injuries, but only one third of the children had relevant trauma related findings in the CT scan. In order to reduce radiation exposure but preserve the advantages of CT, a new algorithm was developed with more flexibility taking the child's age and mental status more into account as well as clinical findings. The mechanism of injury itself is not anymore an indication for CT scanning.

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

“…Our standard protocol group had a lower mean ISS, which could be due to injury mechanisms leading clinicians to opt for WBCT. 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].…”

The Vulnerability of Syrian Immigrant Pediatric Trauma Patients

“…However its high cost and ionizing radiation used on CT that is potentially harmful especially for children are the main handicaps of CT (11). Recently, Muhm et al (12) reported that; among 71 children admitted to the emergency department due to a trauma; 67.6% received a cranial scan and only one third of the children had had relevant trauma related findings in the CT scan. In our study CT scan was obtained in 63 (31.5%) cases and revealed pathology in only 3 of them.…”

Bicycle-Related Injuries in Paediatric Patients

“…11 Our figures compared favourably with figures from studies by Fenton et al and Muhm et al, which reported lower figures of 46% and 33.8% for positive CT findings in paediatric trauma patients. 12,13 This demonstrates that CT scans are being used judiciously in our institution in this context, which may help to ameliorate the burden of paediatric bicycle injuries on the healthcare system and on patients who sustain these injuries. A quarter of our patients required inpatient admission, with 7 (8.6%) patients being admitted to either HD or ICU.…”