Department of General Medicine, Juntendo University, Tokyo, Japan.
Department of Health Services Research, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan.
Pediatr Crit Care Med. 2019 Jun;20(6):e245-e250. doi: 10.1097/PCC.0000000000001898.
We aimed to investigate whether whole-body CT for children with trauma is associated with a different mortality than only selective CT.
A multicenter, retrospective cohort study.
Nationwide trauma registry from 183 tertiary emergency medical centers in Japan.
We enrolled pediatric trauma patients less than 16 years old who underwent whole-body CT or selective CT from 2004 to 2014.
We classified the patients into a whole-body CT group if they underwent head, chest, abdomen, and pelvis CT and a selective CT group if they underwent at least one, but not all, of the above scans.
We analyzed data from 9,170 eligible patients (males, 6,362 [69%]; median age, 9 yr [6-12 yr]). Of these, 3,501 (38%) underwent whole-body CT. The overall in-hospital mortality was 180 of 9,170 (2.0%), that of patients who underwent whole-body CT was 102 of 3,501 (2.9%), and that of patients who underwent selective CT was 78 of 5,669 (1.4%). After adjusted multilevel logistic regressions and propensity score matching, the whole-body CT group demonstrated no significant difference in terms of in-hospital mortality compared with the selective CT group. The adjusted odds ratios (whole-body CT vs selective CT) for in-hospital mortality were as follows: multilevel logistic regression model 1 (1.05 [95% CI, 0.70-1.56]); multilevel logistic regression model 2 (0.72 [95% CI, 0.44-1.17]); propensity score-matched model 1 (0.98 [95% CI, 0.65-1.47]); and propensity score-matched model 2 (0.71 [95% CI, 0.46-1.08]). Subgroup analyses also revealed similarities between CT selection and in-hospital mortality.
In this nationwide study, whole-body CT was frequently used among Japanese children with trauma. However, compared with the use of selective CT, our results did not support the use of whole-body CT to reduce in-hospital mortality. Selective use of imaging may result in less radiation exposure and provide more benefits than whole-body CT to pediatric trauma patients.
本研究旨在探讨与仅行选择性 CT 相比，全身 CT 检查是否会导致儿童创伤患者的死亡率存在差异。
多中心回顾性队列研究。
日本全国 183 个三级急救医疗中心的全国创伤登记处。
纳入 2004 年至 2014 年间行全身 CT 或选择性 CT 检查的年龄＜16 岁的儿科创伤患者。
如果患者行头、胸、腹和骨盆 CT 检查，则将其归入全身 CT 组；如果患者至少行上述扫描中的 1 项，但未行全部，则归入选择性 CT 组。
共纳入 9170 例符合条件的患者（男性 6362 例[69%]；中位年龄 9 岁[612 岁]）。其中 3501 例（38%）行全身 CT 检查。9170 例患者的院内总体死亡率为 180 例（2.0%），行全身 CT 检查患者的院内死亡率为 102 例（2.9%），行选择性 CT 检查患者的院内死亡率为 78 例（1.4%）。经调整后的多水平逻辑回归和倾向评分匹配后，全身 CT 组与选择性 CT 组的院内死亡率无显著差异。多水平逻辑回归模型 1 中，全身 CT 组与选择性 CT 组的院内死亡率的调整比值比（OR）为 1.05（95%CI，0.701.56）；多水平逻辑回归模型 2 中为 0.72（95%CI，0.441.17）；倾向评分匹配模型 1 中为 0.98（95%CI，0.651.47）；倾向评分匹配模型 2 中为 0.71（95%CI，0.46~1.08）。亚组分析也显示 CT 选择与院内死亡率之间的相似性。
在这项全国性研究中，日本儿童创伤患者中经常使用全身 CT。然而，与选择性 CT 相比，我们的结果并不支持使用全身 CT 降低院内死亡率。与全身 CT 相比，选择性使用影像学检查可能会减少辐射暴露，并为儿科创伤患者带来更多获益。
