Rawlins Kasey W, Allen David Z, Onwuka Amanda J, Elmaraghy Charles A
The Ohio State University Wexner Medical Center, Department of Otolaryngology-Head and Neck Surgery, Columbus, OH, USA.
The Research Institute at Nationwide Children's Hospital, Center for Surgical Outcomes Research, Columbus, OH, USA.
Int J Pediatr Otorhinolaryngol. 2019 Aug;123:22-25. doi: 10.1016/j.ijporl.2019.04.027. Epub 2019 Apr 24.
The objective of this study is to examine the impact that an institution-wide policy to reduce radiation exposure in pediatric patients had on the use of computed tomography (CT) imaging in children presenting with suspected peritonsillar abscess (PTA)1.
A single institution retrospective review was conducted for all pediatric patients under the age of 18 who presented to the emergency department with suspected PTA over a ten-year period. Patients were divided into two groups; those that presented during the years prior to policy implementation and those that presented during the years following. Main outcome measures were the frequency of patients who underwent CT scanning as a part of their workup, the specialty of the ordering physician, and the treatment for suspected PTA.
A total of 317 patients with suspected PTA were seen prior to policy implementation, with an additional 275 patients seen in the years after. The frequency of CT use was 41% (131/317) in pre-policy patients, and 28% (77/275) in post-policy patients (p = 0.004). The most common specialty of ordering physician was Pediatrics in the pre-policy patients (45%), and Otolaryngology in the post-policy patients (41%) (p = 0.0003). Of the 131 patient who underwent CT scanning before policy implementation, 36 patients (27%) required incision and drainage (I&D) of their PTA in the OR. This is in comparison to 42/77 patients (55%) in the post-policy group who underwent I&D in the OR (p < 0.0001).
An institution-wide policy to decrease unnecessary imaging studies in pediatric patients resulted in a significant reduction in the use of CT imaging in the work-up for suspected PTA. Additionally, there was increase in the frequency of patients who underwent surgical intervention for their PTA after CT imaging, suggesting a more scrutinized approach to CT usage since policy implementation.
本研究的目的是探讨一项全机构范围内减少儿科患者辐射暴露的政策对疑似扁桃体周围脓肿（PTA）患儿计算机断层扫描（CT）成像使用情况的影响。
对一家机构在十年期间因疑似PTA到急诊科就诊的所有18岁以下儿科患者进行回顾性研究。患者分为两组，一组是在政策实施前几年就诊的患者，另一组是在政策实施后几年就诊的患者。主要观察指标包括作为检查一部分接受CT扫描的患者频率、开单医生的专业以及疑似PTA的治疗情况。
在政策实施前共诊治了317例疑似PTA患者，政策实施后又诊治了275例患者。政策实施前的患者中CT使用率为41%（131/317），政策实施后的患者中CT使用率为28%（77/275）（p = 0.004）。政策实施前开单医生最常见的专业是儿科（45%），政策实施后是耳鼻喉科（41%）（p = 0.0003）。在政策实施前接受CT扫描的131例患者中，有36例（27%）需要在手术室对其PTA进行切开引流（I&D）。相比之下，政策实施后组中有42/77例患者（55%）在手术室接受了I&D（p < 0.0001）。
一项全机构范围内减少儿科患者不必要影像学检查的政策导致疑似PTA检查中CT成像的使用显著减少。此外，CT成像后因PTA接受手术干预的患者频率有所增加，这表明自政策实施以来对CT使用的审查更加严格。
