Computed Tomography for Evaluation of Mild to Moderate Pediatric Trauma: Are We Overusing It?

Abstract

Computed tomography (CT) is used liberally in the evaluation of pediatric trauma, even of low or moderate severity, because clinical examination of pediatric patients is considered unreliable. Appropriate utilization of valuable resources is essential in a cost-conscious medical era. The objective of this study is to determine if children with mild to moderate trauma are evaluated by more CT scans than adults with injuries of similar severity. Altogether, 108 pediatric patients less than 7 years old were matched according to mechanism of injury, Injury Severity Score (ISS), and the six individual body-region Abbreviated Injury Scores with adult patients admitted over the same 2-year period. All these patients had mild or moderate injuries (mean ISS 3.3 +/- 3.4). Pediatric patients had significantly more CT scans than adults, mostly because of a more liberal use of abdominal CT. CT scans of multiple body areas on the same patient were used more frequently in children but failed to identify more injuries compared to adults. None of the pediatric patients required an operation for abnormalities identified by CT. No differences were observed in morbidity, mortality, length of hospital stay, or length of intensive care unit stay for the two groups. It was concluded that a liberal policy of CT scanning for pediatric patients with a low ISS leads to increased resource consumption with no obvious diagnostic or treatment benefit.

Does This Adult Patient Have a Blunt Intra-abdominal Injury?

“…13,14 Current trauma guidelines recommend abdominal CT imaging in patients with unreliable physical examinations; physical examination findings including abdominal tenderness, abdominal wall contusions, or multiple rib fractures; or intraperitoneal fluid on ultrasound. 9 However, less than 20% of abdominal CT scans obtained in patients with blunt trauma are positive for intra-abdominal injury, 15,16 while less than 3% have injuries that require surgical intervention. 17 When overused, abdominal CT scans contribute to increased health care costs and prolonged emergency department (ED) stays and add to the risk of contrast-induced nephropathy and lifetime risk of radiation-induced malignancy.…”

The role of telehealth in pediatric emergency care

“…General EDs transfer children more often than adults, due to less availability of pediatric specialists and lack of comfort and experience with ill children. 22 , 23 , 24 , 25 Tele‐consultation has great impact in diagnosing skin rashes and respiratory illness, as well as determination of intervention need (lacerations, fractures). Tele‐consultation also provides great value in hospital destination decisions for trauma, complex medical problems, and psychiatric care.…”

“…General EDs transfer children more often than adults, due to less availability of pediatric specialists and lack of comfort and experience with ill children 22–25 . Tele‐consultation has great impact in diagnosing skin rashes and respiratory illness, as well as determination of intervention need (lacerations, fractures).…”

Variation in Specialists' Reported Hospitalization Practices of Children Sustaining Blunt Abdominal Trauma

“…More than 600,000 children with blunt abdominal trauma are evaluated annually in United States (U.S.) emergency departments (EDs), many of whom undergo abdominal imaging. When abdominal imaging is performed after blunt trauma, computed tomography (CT) is the test of choice 1,2. However, IAIs are identified in fewer than 20% of children imaged after blunt abdominal trauma 3…”