Application of a Thoracic CT Decision Rule in the Evaluation of Injured Children: A Quality Improvement Initiative

Downie, Katie; McIntire, Alicia; Tobias, Joseph; Krishnaswami, Sanjay; Jafri, Mubeen

doi:10.1097/jtn.0000000000000692

Cited by 2 publications

(1 citation statement)

References 23 publications

(34 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…These post‐guidance publication peaks and subsequent fall in use of the recommended protocol suggest that clinicians need reminding of the recommendations, with further information dissemination and education required both at a national and local level. A recent study showed that the use of a thoracic imaging decision tool reduced the use of CT in pediatric acute trauma by 50% 17 without an increase in missed, clinically significant, injuries.…”

Section: Discussionmentioning

confidence: 99%

Have the UK Pediatric Trauma Protocols resulted in a reduction in chest computed tomography imaging for children presenting with major blunt trauma?

Negus,

Bouamra,

Roland

2023

JACEP Open

View full text Add to dashboard Cite

ObjectivesTo observe variation in imaging requests after publication of the Royal College of Radiologists UK Paediatric Trauma Protocols in 2014, recommending limited use of thoracic computed tomography (CT) to appropriately clinically risk stratified children.MethodA retrospective observational study using data from the Trauma Audit & Research Network in the United Kingdom, for children (0–16 years of age) for the years 2012–2021. Percentages were calculated to facilitate comparison between year groups (under 1 year of age, 1–10 years of age, 11–15 years of age), and CT imaging categories reviewed: (1) whole‐body CT (WBCT); (2) abdominopelvic CT (CTAP) with chest radiograph (CXR); (3) chest, abdomen, and pelvic CT (CTCAP) with CXR; (4) CTCAP without CXR; and (5) other imaging.ResultsIncreased use of the recommended protocol (CXR with CTAP) was observed after guidance publication but was not sustained: infants under 1 year old, 0.0% in 2012, 7% in 2017, 0.0% in 2021; 1–10‐year‐olds, 4% in 2012, 13.9% in 2017, 5.5% in 2021; 11–15‐year‐olds, 7.1% in 2012, 10.2% in 2017, 6.6% in 2021. Requests for WBCT increased from 2012–2021 (all age groups, 2.4%, 2012, to 5.3%, 2021) and requests for CTCAP were consistently at a higher level than that of the recommended protocol.ConclusionThe increased use of CXR with CTAP after publication of the guidelines, was not sustained with a decreasing trend observed from ∼2017, raising concern for the ionizing radiation burden in this population.

show abstract

Section: Discussionmentioning

confidence: 99%

Have the UK Pediatric Trauma Protocols resulted in a reduction in chest computed tomography imaging for children presenting with major blunt trauma?

Negus,

Bouamra,

Roland

2023

JACEP Open

View full text Add to dashboard Cite

show abstract

Disparities in computed tomography utilization for pediatric blunt trauma: a systematic review and meta-analysis comparing pediatric and non-pediatric trauma centers

Hassankhani,

Valizadeh,

Amoukhteh

et al. 2023

Emerg Radiol

View full text Add to dashboard Cite

Pediatric blunt trauma is a major cause of morbidity and mortality, and computed tomography (CT) imaging is vital for accurate evaluation and management. Pediatric trauma centers (PTCs) have selective CT practices, while non-PTCs may differ, resulting in potential variations in CT utilization. The objective of this study is to delineate disparities in CT utilization for pediatric blunt trauma patients between PTCs and non-PTCs. A systematic review and meta-analysis were conducted following established guidelines, searching PubMed, Scopus, and Web of Science up to March 3, 2023. All studies examining CT utilization in the management of pediatric (aged < 21 years) blunt trauma and specifying the type of trauma center(s) were included, and data were extracted and analyzed using STATA software version 17.0. An analysis of 30 studies revealed significant variations in CT scan utilization among pediatric blunt trauma patients across different types of trauma centers. PTCs exhibited lower pooled rates of abdominopelvic CT scans (35.4% vs. 44.9%, p < 0.01), cranial CT scans (36.9% vs. 42.9%, p < 0.01), chest CT scans (14.5% vs. 25.4%, p < 0.01), and cervical spine CT scans (23% vs. 45%, p < 0.01) compared to adult or mixed trauma centers (ATCs/MTCs). PTCs had a pooled rate of 54% for receiving at least one CT scan, while ATCs/MTCs had a higher rate of 69.3% (p < 0.05). The studies demonstrated considerable heterogeneity. These findings underscore the need to conduct further research to understand the reasons for the observed variations and to promote appropriate imaging usage, minimize radiation exposure, and encourage collaboration between pediatric and adult trauma centers.

show abstract

Application of a Thoracic CT Decision Rule in the Evaluation of Injured Children: A Quality Improvement Initiative

Cited by 2 publications

References 23 publications

Have the UK Pediatric Trauma Protocols resulted in a reduction in chest computed tomography imaging for children presenting with major blunt trauma?

Have the UK Pediatric Trauma Protocols resulted in a reduction in chest computed tomography imaging for children presenting with major blunt trauma?

Disparities in computed tomography utilization for pediatric blunt trauma: a systematic review and meta-analysis comparing pediatric and non-pediatric trauma centers

Contact Info

Product

Resources

About