The radiation footprint on the pediatric trauma patient

Abstract

BackgroundThe actual baseline of radiation exposure used in evaluating pediatric trauma is not known and has relied on estimates in the literature that may not reflect clinical reality. Our objectives were to determine the baseline amount of radiation delivered in a pediatric trauma evaluation and correlate radiation exposure with trauma activation status to identify the cohort most at risk.MethodsWe retrospectively evaluated trauma patients (N = 1050) at an independent Level I children’s hospital for each level of trauma activation (consults, alerts, stats) from June 2010 to January 2011. Those patients with full dosimetry (N = 215) were analyzed for demographics, mechanism of injury, Injury Severity Score, imaging modalities, and total effective radiation dosages during the full trauma assessment from the time of injury to discharge.ResultsDemographics included gender (143 males, 72 females) and average age (5.5 years [range < 1–16]). The most radiation was conferred from CTs and greatest in trauma stats, followed by alerts, then consults (p < 0.001 for stat and alert doses compared to consults). Repeated imaging was common: 35% of stats had 2–3 CTs and 40% had 4–10 CTs (range 0–10 CTs). The average non-accidental trauma consult utilized four times as many CTs as the average consult (p = 0.002). Most outside hospital CTs (66%) delivered more radiation: 50.0% were at least double the standard pediatric dosage.ConclusionsThis study is the first to identify the actual baseline of radiation exposure for one trauma evaluation and correlate radiation exposure with trauma activation status. Factors associated with highest radiation include stat activations, suspected non-accidental traumas (NAT), and outside hospital system imaging.

Bildgebung nach Unfall in Klinik und Praxis bei Kindern und Jugendlichen

“…Hier sollten altersgerechte Einstellungsprotokolle der Computertomographen verwendet werden, um die geringste sinnvolle Dosis einzusetzen [ 29 , 38 , 48 , 56 ]. Es sollten diese Niedrigdosen-Pädiatrie-Protokolle und andere Techniken wie Flash-CT, Reduzierung der Dünnschnitt-CT-Bildgebung Anwendung finden [ 4 , 7 , 12 , 13 , 25 , 53 , 54 ]. In Kinderzentren wird allgemein durch vermehrte Nutzung spezieller Kinderprotokolle bei CT-Untersuchungen eine niedrigere Strahlendosis erzielt als in allgemeinen Erwachsenen-Traumazentren [ 18 , 26 ].…”

Pediatric solid organ injury – frequency of abdominal imaging is determined by the treating department

“…[ 9 , 10 ] Children are very susceptible to developing malignancies secondary to ionizing radiation because they are more radiosensitive (owing to the presence of rapidly dividing cells in their bodies) and their longer lifespan throughout a malignancy may manifest. [ 9 , 11 ] Although there is no upper dose limit at the individual level, there are diagnostic reference levels (DRLs) which provide orientation and should not be exceeded in the regular case. However, while following these DRLs CT imaging should be replaced by MRI whenever possible in children.…”