Pediatric evidence-based imaging guidelines for adult trauma providers significantly reduces radiation exposure to children

Abstract

Introduction Evidence suggests that stand-alone pediatric trauma centers outperform adult and combined adult/pediatric trauma centers in limiting radiation exposure to injured children. We sought to determine the impact of implementing evidence-based guidelines for pediatric imaging at a combined adult (level 1) and pediatric (level 2) center. The initiative focused on trauma/critical care surgeons as the pediatric surgeons did not participate in the resuscitation and initial evaluation of injured children. Methods Imaging guidelines were developed from existing clinical studies. After 3 months of education, guidelines were implemented, and regular feedback was given to providers regarding compliance. Data were collected from the trauma registry for all pediatric patients (aged less than 15 years), in calendar years 2017 (pre-guideline) and 2019 (post-guideline). All admissions were analyzed, with subgroup analysis of children with multisystem trauma admitted to the trauma surgery service. Results Following guideline implementation, mean computed tomography (CT) scans per injured child fell by over 50% (.93 vs .45). For patients admitted to the trauma service, the mean fell by 58% (1.82 vs 0.76). The number of patients receiving more than 1 CT significantly decreased for all children (26% vs 10%), and particularly those admitted to the trauma service (52% vs 17%). During this time, there was only one injury missed at the initial admission, which was clinically insignificant (non-displaced skull fracture). Conclusions Implementation of evidence-based guidelines for imaging eliminates disparity in practices between a combined adult/pediatric trauma center and stand-alone pediatric trauma centers.

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

“…Azari et al (2020) describe how implementing a guideline effectively reduced inappropriate TCT rates. More specifically, implementing evidence-based imaging guidelines has been shown to reduce CT in pediatric trauma patients (Wu et al, 2021), and our experience has helped providers stay informed of the unique differences in pediatric clinical practice. Our pediatric trauma imaging guidelines now include pathways for CT scanning of the head, cervical spine, abdomen/pelvis, and thorax.…”

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

“…In a study involving 3,832 pediatric patients with minor head injuries, the utilization of the PECARN rule alone led to a 29% reduction in the rate of head CT scans, all without overlooking clinically significant head traumas [ 54 ]. Another multicentric study on pediatric head trauma indicated that the Pediatric Emergency Care Applied Research Network (PECARN) rule had potential to prevent 396 out of 589 unnecessary head CT scans [ 55 ]. Notably, Wu et al reported a significant 50% reduction in the number of CT scans ordered for pediatric trauma patients through a 3-month evidence-based imaging education program designed for emergency and surgery practitioners [ 56 ].…”