Chwals Walter J, Robinson Ann V, Sivit Carlos J, Alaedeen Diya, Fitzenrider Ellen, Cizmar Laura
Division of Pediatric Surgery, Rainbow Babies and Children's Hospital, Case Western Reserve University School of Medicine, Cleveland, Ohio 44106, USA.
J Pediatr Surg. 2008 Dec;43(12):2268-72. doi: 10.1016/j.jpedsurg.2008.08.061.
Community hospitals commonly obtain computed tomographic (CT) imaging of pediatric trauma patients before triaging to a level I pediatric trauma center (PTC). This practice potentially increases radiation exposure when imaging must be duplicated after transfer.
A retrospective review of our level 1 PTC registry from January 1, 2004, to December 31, 2006, was conducted. Level I and II trauma patients were grouped based on whether they had undergone outside CT examination (head and/or abdomen) at a referring hospital (group 1) or received initial CT examination at our institution (group 2). Subgroups were analyzed based on whether duplicate CT examination was required at our PTC (Fischer's Exact test).
A duplicate CT scan (within 4 hours of transfer) was required in 91% (30/33) of group 1 transfer patients, whereas no group 2 patient required a duplicate scan (0/55; P < .0001). There was no significant difference within the groups for weight, age, or intensive care unit length of stay.
A significant number of pediatric trauma patients who receive CT scans at referring hospitals before transfer to our level I PTC require duplicate scans of the same anatomical field(s) after transfer, exposing them to increase potential clinical risk and cost.
社区医院通常会在将儿科创伤患者分诊至一级儿科创伤中心（PTC）之前，先对其进行计算机断层扫描（CT）成像检查。这种做法在患者转院后若需重复成像时，可能会增加辐射暴露风险。
对我们一级PTC登记处2004年1月1日至2006年12月31日的数据进行回顾性分析。一级和二级创伤患者根据他们在转诊医院是否接受过院外CT检查（头部和/或腹部）（第1组）或在我们机构接受初次CT检查（第2组）进行分组。根据我们的PTC是否需要重复CT检查对亚组进行分析（Fisher精确检验）。
第1组转院患者中有91%（30/33）需要重复CT扫描（转院后4小时内），而第2组患者无人需要重复扫描（0/55；P < 0.0001）。两组在体重、年龄或重症监护病房住院时间方面无显著差异。
大量在转诊医院接受CT扫描后转至我们一级PTC的儿科创伤患者，转院后需要对相同解剖部位进行重复扫描，这增加了他们潜在的临床风险和费用。
