North Carolina Children's Hospital, Chapel Hill, NC, USA.
J Pediatr Surg. 2010 Oct;45(10):2019-24. doi: 10.1016/j.jpedsurg.2010.06.007.
We hypothesized that pediatric blunt trauma patients, initially evaluated at nontrauma centers with abdominal computed tomography (CT) scans, often undergo repeat scans after transfer. This study was designed to quantify this phenomenon, assess consequences, and elucidate possible causes.
This article is an institutional review board-approved, retrospective chart review of pediatric blunt abdominal trauma patients transferred to a level I trauma center from 2002 to 2007 and evaluated with abdominal CT at the trauma center or at a referring facility.
A total of 388 patients met the study criteria, with 6 patients being excluded because of inability to verify outside records resulting in study group of 382 patients. Of those 382 patients, 199 (52%) underwent abdominal CT before transfer. Thirty-six (18%) of those 199 patients underwent repeat CT scanning at our level I trauma center. Of these 36 patients, 19 (53%) were transferred without their outside CT scans, with 10 (53%) of these 19 having significant abdominal injuries. Of the remaining 17, 6 (17%) had repeat scans to assess changes in vital signs, or patient condition, or because of inadequate outside imaging. The remaining 11 (30%) were repeated despite an acceptable outside CT and no change in patient condition. Only 2 of 11 resulted in changed management. Additional radiation delivered from these repeat scans totaled 180 mSv, and additional patient charges totaled more than $110,000. There was an apparent trend toward increased repeat scanning (from 6.7% in 2002 to 16.7% in 2007).
Abdominal CT scans, for evaluation of pediatric blunt trauma, are frequently repeated after transfer from outside hospitals. In many cases, repeat scans provide useful diagnostic information. However, more than 80% of repeat scanning is potentially preventable with better education of transport personnel (paramedics, emergency medical technicians, and nurses) and emergency department physicians.
我们假设，最初在非创伤中心接受腹部计算机断层扫描（CT）检查的儿科钝性创伤患者，在转至创伤中心后通常会进行重复扫描。本研究旨在量化这一现象，评估其后果，并阐明可能的原因。
本研究是一项经机构审查委员会批准的回顾性图表审查，纳入了 2002 年至 2007 年期间从创伤中心转至一级创伤中心的儿科钝性腹部创伤患者，并对其在创伤中心或转诊机构进行了腹部 CT 评估。
共有 388 名患者符合研究标准，其中 6 名患者因无法核实外部记录而被排除在外，导致研究组有 382 名患者。在这 382 名患者中，199 名（52%）在转诊前接受了腹部 CT 检查。其中 199 名患者中有 36 名（18%）在我院一级创伤中心接受了重复 CT 扫描。在这 36 名患者中，19 名（53%）在未携带外部 CT 扫描的情况下转至我院，其中 10 名（53%）患者有明显的腹部损伤。其余 17 名患者中，有 6 名（17%）是因为生命体征或患者病情发生变化而进行重复扫描，或者是因为外部影像学检查不充分。其余 11 名（30%）患者尽管外部 CT 检查结果可接受且患者病情无变化，仍进行了重复扫描。这 11 名患者中只有 2 名的治疗方案发生了改变。这些重复扫描总共增加了 180 毫西弗的辐射剂量，患者的额外费用超过 11 万美元。重复扫描的比例呈明显上升趋势（从 2002 年的 6.7%上升至 2007 年的 16.7%）。
儿科钝性创伤患者在从外院转至我院后，其腹部 CT 检查常重复进行。在许多情况下，重复扫描提供了有用的诊断信息。然而，通过更好地教育转运人员（包括护理人员、急诊医疗技术员和护士）和急诊医生，超过 80%的重复扫描是可以预防的。
