Imaging before transfer to designated pediatric trauma centers exposes children to excess radiation

Puckett, Yana; Bonacorsi, Louis; Caley, Matthew; Farmakis, Shannon G.; Fitzpatrick, Colleen; Chatoorgoon, Kaveer; Greenspon, Yosef; Vane, Dennis W.

doi:10.1097/ta.0000000000001074

Cited by 11 publications

(15 citation statements)

References 32 publications

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“…26 Regarding the risk of CT scans in children, as required by 2 patients in this current paper, the literature advises to do CT scans on children in pediatric hospitals becuase they substantially reduce the radiation received by the children. [27][28][29] Although the radiation dose from a single CT scan is relatively low, when adult-sized imaging techniques are used, children receive a higher radiation dose. 30 The children's hospital where the interventions took place in this study employs only specialized pediatric radiologists who strictly follow the "as low as reasonably achievable" principle, using pediatric imaging protocols and the newest scanner technology.…”

Section: Discussionmentioning

confidence: 99%

Manipulation Under Anesthesia in Infants With Arthrogenic Newborn Torticollis: A Retrospective Case Series

Paravicini

2018

Journal of Chiropractic Medicine

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Objective: The purpose of this report is to describe the manipulation under anesthesia (MUA) treatment of 6 infants with newborn torticollis with a segmental dysfunction at C1/C2. Clinical Features: Six infants aged 4 1/2 to 15 months previously diagnosed with newborn torticollis were referred to a doctor of chiropractic owing to a failure to respond adequately to previous conservative therapies. Common physical findings were limited range of motion of the upper cervical spine. Radiographs demonstrated rotational malpositions and translation of atlas on axis in all 6 infants, and 1 had a subluxation of the C1/C2 articulation. Interventions and Outcome: Selection was based on complexity and variety of different clinical cases qualifying for MUA. Treatment consisted of 1 mobilization and was performed in the operating room of a children's hospital by a certified chiropractic physician with the author assisting. Along with the chiropractor and his assistant, a children's anesthesiologist, 1 to 2 operating nurses, a children's radiologist, and in 1 case a pediatric surgeon were present. Before the mobilization, plain radiographs of the cervico-occipital area were taken. Three infants needed further investigation by a pediatric computed tomography scan of the area because of asymmetric bony conditions on the plain radiographs. Follow-up consultations at 2, 3, 5, or 6 weeks were done. Patient records were analyzed for restriction at baseline before MUA compared with after MUA treatment for active rotation, passive rotation, and passive rotation in full flexion of the upper cervical spine. All 3 measurements showed significant differences. The long-term outcome data was collected via phone calls to the parents at 6 to 72 months. The initial clinical improvements were maintained. Conclusion: These 6 infants with arthrogenic newborn torticollis, who did not respond to previous conservative treatment methods, responded to MUA.

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Section: Discussionmentioning

confidence: 99%

Manipulation Under Anesthesia in Infants With Arthrogenic Newborn Torticollis: A Retrospective Case Series

Paravicini

2018

Journal of Chiropractic Medicine

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“…11 Previous studies have shown that patients imaged at community-based RFs are exposed to higher CT scan radiation dosages when compared with patients imaged at PTCs. 6,12 These studies analyzed patients imaged in the early 2010s, shortly after the "Image Gently" campaign to reduce pediatric CT radiation dose. Our study sought to determine whether such differences in CT scan-related radiation dosages have persisted as well as to see if there are any identifiable characteristics of either patients or RFs that may be associated with increased radiation exposure.…”

Section: Discussionmentioning

confidence: 99%

An Analysis of Computed Tomography-Related Radiation Exposure in Pediatric Trauma Patients

Hrdy

Mahesh²,

Miller

et al. 2021

Pediatr Emer Care

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Objective: To compare radiation doses used for pediatric computed tomography (CT) scans at community-based referring facilities (RF) to those at a designated pediatric trauma center (PTC) to assess the consistency of radiation exposure. Methods:In this retrospective study, patients 0 to 18 years of age with CT imaging performed either at a RF or at a PTC from January 1, 2015, to January 5, 2016, were identified. Data about patients, CT radiation dose, and characteristics of the RFs were compared. Results:We identified 502 patients (156 RF, 346 PTC) with 281 head CTs (79 RF, 202 PTC) and 86 abdominal/pelvis CTs (28 RF, 58 PTC). The radiation dose (measured in mean dose-length product [DLP] ± 1 standard deviation) was significantly higher for RF scans compared with PTC scans (head, RF DLP = 545 ± 334 vs PTC DLP = 438 ± 186 (P < 0.001); abdomen/pelvis, RF DLP = 279 ± 160 vs PTC DLP = 181 ± 201 [P = 0.027]). There was a nonsignificant trend toward lower head CT radiation dosages at RFs with a dedicated pediatric emergency department compared with RFs without a pediatric emergency department.Conclusions: Our data suggest that CT scans performed at RFs expose pediatric patients to significantly higher doses of radiation when compared with a PTC. These data support further study to identify factors associated with increased radiation and educational outreach to RFs.

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“…12 In addition, there have been studies from several institutions around the country demonstrating that dedicated children's hospitals have been more successful in implementing lower CT radiation dosing in pediatric patients when compared with AGHs for a broad range of clinical indications, including trauma. [26][27][28][29][30][31] This remains true even if the referring institution is a trauma center. 32 Indeed, when we split our AGHs into trauma centers and non-trauma centers, we found a similarly significant dose reduction for both.…”

Section: Discussionmentioning

confidence: 99%

Variation in radiation dosing among pediatric trauma patients undergoing head computed tomography scan

LaQuaglia

Anderson

Goodhue

et al. 2021

J Trauma Acute Care Surg

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BACKGROUND:When head injured children undergo head computed tomography (CT), radiation dosing can vary considerably between institutions, potentially exposing children to excess radiation, increasing risk for malignancies later in life. We compared radiation delivery from head CTs at a level 1 pediatric trauma center (PTC) versus scans performed at referring adult general hospitals (AGHs).We hypothesized that children at our PTC receive a significantly lower radiation dose than children who underwent CTat AGHs for similar injury profiles. METHODS:We retrospectively reviewed the charts of all patients younger than 18 years who underwent CT for head injury at our PTC or at an AGH before transfer between January 1 and December 31, 2019. We analyzed demographic and clinical data. Our primary outcome was head CT radiation dose, as calculated by volumetric CT dose index (CTDI vol ) and dose-length product (DLP; the product of CTDI vol and scan length). We used unadjusted bivariate and multivariable linear regression (adjusting for age, weight, sex) to compare doses between Children's Hospital Los Angeles and AGHs. RESULTS:Of 429 scans reviewed, 193 were performed at our PTC, while 236 were performed at AGHs. Mean radiation dose administered was significantly lower at our PTC compared with AGHs (CTDI vol 20.3/DLP 408.7 vs. CTDI vol 30.6/DLP 533, p < 0.0001). This was true whether the AGH was a trauma center or not. After adjusting for covariates, findings were similar for both CTDI vol and DLP. Patients who underwent initial CT at an AGH and then underwent a second CT at our PTC received less radiation for the second CT (CTDI vol 25.6 vs. 36.5, p < 0.0001). CONCLUSIONS:Head-injured children consistently receive a lower radiation dose when undergoing initial head CT at a PTC compared with AGHs. This provides a basis for programs aimed at establishing protocols to deliver only as much radiation as necessary to children undergoing head CT.

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Imaging before transfer to designated pediatric trauma centers exposes children to excess radiation

Abstract: Therapeutic study, level IV.

Cited by 11 publications

References 32 publications

Manipulation Under Anesthesia in Infants With Arthrogenic Newborn Torticollis: A Retrospective Case Series

Manipulation Under Anesthesia in Infants With Arthrogenic Newborn Torticollis: A Retrospective Case Series

An Analysis of Computed Tomography-Related Radiation Exposure in Pediatric Trauma Patients

Variation in radiation dosing among pediatric trauma patients undergoing head computed tomography scan

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