Does Pan-Scan Benefit Pediatric Trauma Patients?

Spoon Feed
Whole body CT vs selective CT in children with trauma did not result in mortality benefit.  This large, retrospective study with propensity matching suggested that any additional injuries found on pan-CT may have been either not life-threatening or did not change management to produce mortality benefit.

Why does this matter?
Radiation exposure is dangerous.  The risks are small but real.  If you have not read these, please take a minute to do so.  They are all free full text.  This sentinel article in Lancet 2012 found there would be one excess case of brain cancer and one excess case of leukemia per 10,000 head CTs in children under 10 years.  Brenner wrote another widely cited and scary article in 2007 that woke us up to the risks of CT.  Berrington de Gonzalez in 2009 shook us all with this article which includes a table of lifetime cancer risks that is truly frightening.  Relevant to today's article, she noted that lifetime risk of cancer attributed to whole-body CT for a 3 year old girl is 60 per 10,000 scans; 30/10,000 for a 3 year old boy.  So if we are planning whole body CT in children, the risk of serious injury needs to outweigh the risk of CT-based radiation.

Stop knee-jerk pan-scan in kids!
This was a multi-center National Trauma Data Bank retrospective review of 8757 children 6 months to 14 years who underwent whole body CT (WBCT), defined as head, chest, abdomen/pelvis within 2 hours of arrival.  On unadjusted analysis, those who received WBCT had higher mortality than those with selective CT.  Of course, this was due to the fact that children undergoing WBCT were more severely injured.  Using propensity score matching, they found 7-day mortality was roughly 0.9% for children with or without WBCT.  There was no subgroup identified who benefitted from WBCT.  What this suggested was that any injuries identified on WBCT were not life threatening and did not change management often enough to result in mortality benefit.  This study was limited by its retrospective nature, even with propensity matching.  But it suggested that a selective CT approach was the right way to image injured children and that WBCT did not detect enough unsuspected life threatening injuries to warrant the increased risk of radiation and cost.

Source
Association of Whole-Body Computed Tomography With Mortality Risk in Children With Blunt Trauma.  JAMA Pediatr. 2018 Apr 9. doi: 10.1001/jamapediatrics.2018.0109. [Epub ahead of print]

Another Spoonful
This article and the rest of Simon Carley's Top Ten Trauma Articles are discussed in this outstanding post.

Peer reviewed by Thomas Davis

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