Department of Pediatrics, University of Arkansas for Medical Sciences, College of Medicine, Little Rock, Arkansas; Arkansas Children's Research Institute, Little Rock, Arkansas.
Department of Pediatric Radiology, University of Arkansas for Medical Sciences, College of Medicine, Little Rock, Arkansas.
J Am Coll Radiol. 2018 Jan;15(1 Pt A):58-64. doi: 10.1016/j.jacr.2017.06.035. Epub 2017 Aug 25.
Use of cranial CT scans in children has been increasing, in part due to increased awareness of sports-related concussions. CT is the largest contributor to medical radiation exposure, a risk factor for cancer. Long-term cancer risks of CT scans can be two to three times higher for children than for adults because children are more radiosensitive and have a longer lifetime in which to accumulate exposure from multiple scans.
To compare the radiation exposure injured children receive when imaged at nonpediatric hospitals (NPHs) versus pediatric hospitals.
Injured children younger than 18 years who received a CT scan at a referring hospital during calendar years (CYs) 2010 and 2013 were included. Patient-level factors included demographics, mode of transportation, and Injury Severity Score, and hospital-level factors included region of state, radiology services, and hospital type and size. Our primary outcome of interest was the effective radiation dose.
Four hundred eighty-seven children were transferred to the pediatric trauma center during CYs 2010 and 2013, with a median age of 7.2 years (interquartile range 5-13). The median effective radiation dose received at NPHs was twice that received at the pediatric trauma center (3.8 versus 1.6 mSv, P < .001). Results were confirmed in independent and paired analyses, after controlling for mode of transportation, emergency department disposition, level of injury severity, and at the NPH trauma center level, hospital type, size, region, and radiology services location.
NPHs have the potential to substantially reduce the medical radiation received by injured children. Pediatric CT protocols should be considered.
儿童头颅 CT 扫描的应用有所增加，部分原因是人们对与运动相关的脑震荡的认识有所提高。CT 是医疗辐射暴露的最大因素，也是癌症的一个风险因素。由于儿童对辐射更敏感，而且一生中会因多次扫描而积累更多的辐射暴露，因此儿童接受 CT 扫描的长期癌症风险比成年人高出两到三倍。
比较受伤儿童在非儿科医院（NPH）和儿科医院接受影像学检查时所接受的辐射暴露。
纳入在 2010 年和 2013 年的日历年期间，在转诊医院接受 CT 扫描的年龄小于 18 岁的受伤儿童。患者层面的因素包括人口统计学特征、运输方式和损伤严重程度评分，医院层面的因素包括州的区域、放射科服务以及医院类型和规模。我们主要关注的结果是有效辐射剂量。
在 2010 年和 2013 年的日历年期间，有 487 名儿童被转至儿科创伤中心，中位数年龄为 7.2 岁（四分位距 5-13 岁）。在 NPH 接受的有效辐射剂量中位数是在儿科创伤中心的两倍（3.8 与 1.6 mSv，P <.001）。在独立和配对分析中，在控制了运输方式、急诊部门处置、损伤严重程度级别以及 NPH 创伤中心的医院类型、规模、区域和放射科服务位置后，结果得到了确认。
NPH 有可能大幅减少受伤儿童接受的医疗辐射。应考虑儿科 CT 方案。
