More CT in Pediatric Trauma – Same Mortality, More Radiation

Written by Aaron Lacy

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Children suffering from severe blunt trauma underwent less CT imaging at level 1 pediatric trauma centers (PTCs) when compared to level 2 PTCs or adult level 1 or 2 trauma centers (ATCs), with no significant difference in mortality.

Why does this matter?
Radiation exposure is associated with increased future risk of cancer, and this risk goes up the younger the patient and higher the exposure dose.  If it is safe to use selective imaging in a pediatric population, we must do so to decrease future harm to our patients.

Pediatric Pan Scan? First do no harm.
A retrospective analysis of pediatric trauma patients (age <18) with an injury severity scale score >15 (consistent with severe trauma) at level 1 PTCs (N = 1,426) or level 1 or 2 ATCs (N = 4816) was done, looking at mortality as a primary outcome.  39.6% and 21.9% of patients at the PTCs received abdominal and thoracic CT scans, respectively; versus 45.5% and 34.7% at ATCs. There was no difference in rate of head CT scanning between PTCs and ATCs. There was no significant difference in mortality between patients treated in the PTC versus ATC groups (p = 0.1198).  Additionally, there was no significant difference in hospital LOS (p=0.2796) or ventilator free days (p = 0.1327).

This is another study showing that a trauma pan-scan in pediatric patients is probably not necessary. My current institution teaches selective imaging in pediatric trauma patients, and I will continue to follow this lead no matter where I end up.

Source
Comparison of Computed Tomography Use and Mortality in Severe Pediatric Blunt Trauma at Pediatric Level I Trauma Centers Versus Adult Level 1 and 2 or Pediatric Level 2 Trauma Centers. Pediatr Emerg Care. 2020 Jul 9. doi: 10.1097/PEC.0000000000002183. [Epub ahead of print]

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