E. Mahdi1, N. Toscano1, R. Dorman1, C. Davis2, A. Brayer2, J. Sanders3, M. Chess4, C. Gitzelmann1, W. Pegoli1, D. Wakeman1 1University Of Rochester,Department Of Surgery,Rochester, NY, USA 2University Of Rochester,Department Of Emergency Medicine,Rochester, NY, USA 3University Of Rochester,Department Of Orthopedics,Rochester, NY, USA 4University Of Rochester,Department Of Imaging Sciences,Rochester, NY, USA
Introduction:
Radiation poses significant risks to pediatric patients. We previously retrospectively validated algorithms to reduce unnecessary computed tomography (CT) scanning in pediatric blunt trauma patients. We hypothesized that prospective implementation of these algorithms would reduce unnecessary CTs.
Methods:
Imaging algorithms for the head, cervical spine, chest, and abdomen/pelvis were prospectively employed during pediatric trauma team activations starting July 2017. A historical control group from 07/2016–12/2016 was compared to the intervention group from 07/2017–12/2017. Chart review was performed and imaging practices were compared. Patients with penetrating mechanism, suspicion of non-accidental trauma, and CT imaging prior to arrival during the intervention group were excluded.
Results:
During the control period 63 CT scans were performed in 24 patients vs. 54 scans in 34 patients after intervention. The number of CTs performed per patient per month (mean 2.7 vs 1.6, median 2.75 vs 1.5), the number of scans not indicated by guidelines per month (mean 4.5 vs 2, median 5 vs 1.5), and the number of CTs not indicated by guidelines per patient per month (mean 1.2 vs 0.4, median 1.1 vs 0.4) all decreased after implementation of imaging guidelines. Injury severity score did not differ between groups. No clinically significant missed injuries were observed.
Conclusion:
Implementing imaging algorithms for traumatically injured children reduced non-indicated CT scans by 56% without compromising care. This practice reduces radiation exposure, health care costs, and time away from monitored care in a vulnerable patient population. Development of electronic tools may simplify and increase algorithm usage.
