Pediatric Pan-Scan Probably Pointless

Written by Clay Smith

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Pan-scan (whole body CT) vs selective CT did not impact in-hospital mortality in traumatized children ≤16 years old.

Why does this matter?
The amount of radiation required to CT scan the head, c-spine, chest, abdomen, and pelvis is not trivial. 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. Last year, a nearly identical study from a different registry reached the same conclusion as this study. REACT-2 gave us a RCT in adults that showed pan-scan was also not beneficial in reducing in-hospital mortality.

Pan scan saves lives…not
This was a multicenter retrospective study of patients ≤16 years in Japan who had trauma and underwent selective or whole body CT. They found the selective CT group had a lower unadjusted mortality of 1.4%, vs 2.9% in the pan-scan group. The problem is that selective CT may have been ordered because the patient was less severely injured, making it falsely appear that these patients fared better. However, there was no difference in the adjusted odds ratio for in-hospital mortality using two different multiple logistic regression models and two propensity score matching models (0.98 [95% CI, 0.65–1.47], model 1) to account for severity of illness. We can’t make a definitive statement based on this retrospective study, but it gives more evidence that pan-scan vs selective CT in children is unhelpful in identifying life threatening injuries that impact mortality.

Source
Is Whole-Body CT Associated With Reduced In-Hospital Mortality in Children With Trauma? A Nationwide Study. Pediatr Crit Care Med. 2019 Feb 5. doi: 10.1097/PCC.0000000000001898. [Epub ahead of print]

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