Department of Radiology, Comparative Effectiveness, Cost, and Outcomes Research Center, University of Washington, 325 Ninth Ave, Box 359960, Seattle, WA 98104, USA.
Radiology. 2013 May;267(2):479-86. doi: 10.1148/radiol.13120865. Epub 2013 Feb 25.
To evaluate the 15-year trend in the use of computed tomography (CT) in hospitalized pediatric trauma patients admitted to Harborview Medical Center (HMC) from 1996 to 2010.
This Health Insurance Portability and Accountability Act-compliant retrospective study was approved by the institutional review board. The requirement for informed consent was waived. The HMC trauma registry was linked to the billing department data, and patient and injury-related characteristics were extracted, in addition to type and frequency of CT procedures. Patients discharged from the emergency department and patients hospitalized for less than 24 hours were not included in this study. Patients were classified into three categories according to age: 0-14 years, 15-18 years, and 19-54 years (reference group). Multivariate negative binomial regression was used to compare CT usage among different age groups by adjusting for patient sex, race and/or ethnicity, insurance status, mechanism of injury, injury severity, final disposition (dead vs alive), and year of admission. The trend for CT use in children and teenagers was also evaluated.
A total of 64 425 trauma patients 0-54 years of age were admitted during the study period. Compared with CT usage in adults 19-54 years old, usage in children up to 15 years of age was significantly lower for spine (incidence rate ratio [IRR], 0.89; 95% confidence interval [CI]: 0.85, 0.92), maxillofacial (IRR, 0.89; 95% CI: 0.81, 0.97), and thoracic (IRR, 0.91; 95% CI: 0.84, 0.99) CT. Increased use of head CT was observed in children up to 15 years old (IRR, 1.09; 95% CI: 1.05, 1.13) and 15-18 years old (IRR, 1.08; 95% CI: 1.04, 1.13). From 2008 to 2010, usage rates in children up to 15 years old and 15-18 years old was relatively unchanged or slightly decreased for almost all CT types.
A decreasing or unchanged trend was observed in CT usage in hospitalized pediatric trauma patients in recent years. © RSNA, 2013.
评估 1996 年至 2010 年期间，因创伤入住美国华盛顿州西雅图市海港景医疗中心（Harborview Medical Center，HMC）的儿科住院患者中，使用计算机断层扫描（computed tomography，CT）的 15 年趋势。
本研究符合《健康保险携带和责任法案》的规定，并获得了机构审查委员会的批准。豁免了知情同意的要求。HMC 创伤登记处与计费部门的数据相链接，并提取了患者和损伤相关特征，以及 CT 检查的类型和频率。本研究不包括从急诊科出院和住院时间少于 24 小时的患者。患者按年龄分为 3 组：0-14 岁、15-18 岁和 19-54 岁（参考组）。采用多变量负二项回归，通过调整患者性别、种族/民族、保险状况、损伤机制、损伤严重程度、最终去向（死亡与存活）和入院年份，比较不同年龄组 CT 的使用情况。还评估了儿童和青少年 CT 使用的趋势。
在研究期间，共收治了 64 425 名 0-54 岁的创伤患者。与 19-54 岁成年人相比，0-15 岁儿童的脊柱（发病率比 [incidence rate ratio，IRR]，0.89；95%置信区间 [confidence interval，CI]：0.85，0.92）、颌面（IRR，0.89；95% CI：0.81，0.97）和胸部（IRR，0.91；95% CI：0.84，0.99）CT 的使用率显著降低。0-15 岁和 15-18 岁儿童的头部 CT 使用率增加（IRR，1.09；95% CI：1.05，1.13）和 1.08；95% CI：1.04，1.13）。2008 年至 2010 年，0-15 岁和 15-18 岁儿童的 CT 使用率在几乎所有类型的 CT 中均保持不变或略有下降。
近年来，住院儿科创伤患者的 CT 使用呈下降或不变趋势。©RSNA，2013。
