Computed tomography in the evaluation of pediatric trauma: We are still overdoing it!

Abstract

Many studies have attempted to define which injured children should undergo computed tomography (CT) imaging. Specifically, the Pediatric Emergency Care Applied Research Network (PECARN), a conglomerate of pediatric trauma centers, prospectively collected data on a large population of patients and have published multiple studies with recommendations on when to image based on the likelihood of a clinically important injury. Using these data and others, the Utah Pediatric Trauma Network (UPTN) created guidelines to help determine when imaging of injured children should be performed at our participating non-pediatric hospitals (non-PED1). The purpose of this study was to evaluate compliance to these guidelines. The UPTN REDCap® database was retrospectively reviewed between 1/2019-12/2022. An analysis of injured Utah children who underwent CT imaging based on UPTN guidelines was performed. Of the 5224 cases reviewed, 4162 (80 %) underwent CT scan for evaluation, of which 3275 (79 %) received CT imaging at a non-PED1 center. Those treated at a non-PED1 hospital tended to be older (mean 10.2 v. 9.1 years, p = 0.002) and more likely to be ≥ 14 years (33 %v.28 %,p = 0.003). They were also less likely to have a traumatic brain injury (81 %v.91 %,p < 0.0001) or an orthopedic injury (14 %v.21 %,p < 0.0001). Children treated at non-PED1 hospitals were less likely to undergo a CT of the head (59 % v. 88 %,p < 0.0001) and abdomen (18 % v. 32 %,p < 0.0001), but more likely of the chest (17 %v.11 %,p = 0.01) or a pan scan (13 %v.8 %,p = 0.001). Compliance to guidelines was lower compared to the PED1 center for CT of the head (67 %v.87 %,p < 0.0001). Overall, compliance increased in the later years of the study for cervical spine and abdomen/pelvis (p = 0.0002,p < 0.0001 respectively), and decreased for head (p = 0.001). Across Utah, CT imaging is highly utilized in the evaluation of injured children. Non-compliance to imaging guidelines was found to be highest for imaging of the cervical-spine, chest, and abdomen. Level III, Prognostic/epidemiological.