Sustaining the gains: Reducing unnecessary computed tomography scans in pediatric trauma patients

Mahdi, Elaa; Toscano, Nicole; Pierson, Lauren M.; Ndikumana, Eric; Ayers, Brian; Chacon, Alexander; Brayer, Anne; Chess, Mitchell; Davis, Colleen O.; Dorman, Robert; Livingston, Michael H.; Arca, Marjorie J.; Wakeman, Derek

doi:10.1016/j.jpedsurg.2022.09.027

Cited by 3 publications

(1 citation statement)

References 36 publications

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“…[ 10 ] CT scanning is easier to use in pediatric trauma patients and does not require patient cooperation. [ 11 ] Therefore, the majority of health-care services, including our own, perform a CT scan of orbita before the first repair of the injury. CT findings in traumatized eyes usually match clinical findings.…”

Section: Introductionmentioning

confidence: 99%

The relationship between computed tomography findings and ocular trauma and pediatric ocular trauma scores in pediatric globe injuries: Does imaging have prognostic and diagnostic value?

Pirhan

2023

Ulus Travma Acil Cerrahi Derg

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BACKGROUND: The aim of this study is to assess the relationship between computed tomography (CT) findings in open globe injuries (OGIs) in pediatric patients and the pediatric ocular trauma score (POTS) and OTS in pediatric ocular trauma. METHODS: In 34 pediatric patients with OGI, CT findings were categorized into nine main categories: Scleral irregularity, lens dislocation, abnormal vitreous density, choroid-retinal layer thickening, preseptal thickness increase, intraocular foreign body and air, vitreous hemorrhage, retinal detachment, and perforation. The relationship between different types and numbers of CT findings and the POTS and OTS was evaluated. RESULTS: The mean age of trauma was 6.6±3.1. Of the patients, 9 (26.5%) were female and 25 (73.5%) were male. The most common CT findings are scleral irregularity and increased preseptal thickness (47.1%). In univariate analysis, a P<0.05 was found between 16 patients with 1 or less CT findings (median POTS value 80 [71.25–90.0]) and 11 patients with 2 or 3 CT findings (median POTS value 60 [15–70]). A P<0.05 was found between 16 patients with 1 or less CT findings (median POTS value 80 [71.25–90.0]) and 7 patients with 4 or more CT findings (median POTS value 45 [25–80]). A P > 0.05 was found between 11 patients with 2 or 3 CT findings (median POTS value 60 [15–70]) and 7 patients with 4 or more CT findings (median POTS value 45 [25–80]). No significant difference was found between the number of CT findings and OTS stages. While POTS was significant (P<0.05) in patients with abnormal vitreous density (median 45 [30–69.6]), OTS value was not significant (P>0.05). There was no significant difference between POTS and OTS in other CT findings. CONCLUSION: The number of CT findings may assist in predicting POTS and, consequently, estimating visual prognosis in pediatric patients with OGI. In emergency situations where, sufficient clinical data are unavailable, the objective findings from CT may help in assessing the severity of ocular trauma and potentially predicting long-term visual outcomes.

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Section: Introductionmentioning

confidence: 99%

The relationship between computed tomography findings and ocular trauma and pediatric ocular trauma scores in pediatric globe injuries: Does imaging have prognostic and diagnostic value?

Pirhan

2023

Ulus Travma Acil Cerrahi Derg

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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

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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.

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Letter to the Editor in Response to: Reducing Unnecessary Computed Tomography Scan

Kapısız

Kaya

Eryılmaz

et al. 2023

Journal of Pediatric Surgery

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Sustaining the gains: Reducing unnecessary computed tomography scans in pediatric trauma patients

Cited by 3 publications

References 36 publications

The relationship between computed tomography findings and ocular trauma and pediatric ocular trauma scores in pediatric globe injuries: Does imaging have prognostic and diagnostic value?

The relationship between computed tomography findings and ocular trauma and pediatric ocular trauma scores in pediatric globe injuries: Does imaging have prognostic and diagnostic value?

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

Letter to the Editor in Response to: Reducing Unnecessary Computed Tomography Scan

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