S.P. Hurley1, S.C. Burjonrappa1 1Rutgers Robert Wood Johnson Medical School, Department Of Pediatric Surgery, New Brunswick, NEW JERSEY, USA
Introduction: Many previous studies have detailed the long term effects and risks of Computer Tomography (CT) imaging in pediatric populations, specifically putting patients at a higher risk of developing cancer. In pediatric trauma, research has shown trauma indices are effective markers in determining the level of care appropriate for each situation. Due to the increased rates of leukemia and lymphoma in patients after having CT imaging during childhood, efforts have been made to reduce exposure of children to CT imaging. This paper sought out to determine if Reverse shock index times Glasgow Motor Component (rSIM), is an effective predictor in determining need for CT imaging.
Methods: Data was used from the American College of Surgeons National Trauma Data Bank (NTDB) from the years 2017-2020. All pediatric patients ranging in age from 1-16 with recorded prehospital systolic blood pressure (EMS SBP), heart rate (EMS HR), and Glasgow coma score motor component (EMSGCSMOTOR) who received CT imaging were in included in the study. This study used data from prior studies which determined abnormal rSIM cutoffs in pediatric age groups as follows: ≤3.4, ≤4.5, ≤5.1, and ≤6.2 for age groups 1-2, 3-5, 6-12, and 13-16. Need for CT imaging was determined by secondary procedure to any major body cavity including craniotomy, intracranial device placement, spinal procedures, neck/airway surgeries, thoracotomy, and laparotomy.
Results: 63,726 patients were included in the study, of those patients 5,170 (8.11%) had abnormal CT findings followed up with surgical procedure. In the patient population of those who received CT imaging, there were 12,202 (19.14%) with abnormal rSIM values. Across all age groups, patients with abnormal rSIM had a rate greater than 3 times higher of having a secondary procedure following CT imaging than patients with normal rSIM (18.5% vs 5.63%, p<0.00001).
Conclusion: Reverse Shock Index times Glasgow Motor Component is deemed to be an effective predictor in the outcome of CT imaging based on need for follow up with major surgical intervention. In the future, rSIM can be used as a quantitative marker in pediatric trauma situations to determine the risks and benefits of CT imaging in pediatric trauma.