Department of Surgery, Albany Medical College, Albany, NY.
Department of Surgery, Albany Medical College, Albany, NY.
J Pediatr Surg. 2020 Sep;55(9):1766-1772. doi: 10.1016/j.jpedsurg.2020.01.006. Epub 2020 Jan 24.
Liberal use of CT scanning in children with blunt trauma risks unnecessary radiation exposure and cost. Recent literature questions the utility of whole-body CT in stable children without clinical evidence of significant injury, but this is often done based on injury mechanism. The purpose of this study is to quantify the utilization of CT scans of the head, chest, abdomen, and pelvis based on injury severity in these body regions and to assess the impact of American College of Surgeons (ACS) pediatric trauma center designation on CT utilization in children with minor or no injuries.
We queried the National Trauma Databank for 2014, 2015, and 2016 to identify all patients 14 years and younger. Using Abbreviated Injury Scale (AIS) score as a proxy for injury severity, we analyzed the number of head, thoracic, and abdominal CT scans done for patients at low levels of injury severity (AIS 0-2) in each of these body regions and according to trauma center level designation (ACS I, II, III, standalone pediatric I or II, and non ACS accredited).
Of 257,661 children who were entered into the database for any reason, overall CT utilization was 20% for head, 5% for the chest and 9% for the abdomen and pelvis. Children with no injuries or minimal injury to the head were scanned 7% and 46% of the time, respectively, for the chest 3% and 13% and for the abdomen 6% and 30%. For all body regions and all levels of injury severity, level 1 stand-alone pediatric centers displayed significantly lower CT utilization rates than others.
CT scan rates for children with minimal or no injuries to the head, chest, abdomen and pelvis are significant. Level 1 stand-alone pediatric trauma centers are least likely to perform these studies. Widespread education and acceptance of clinical guidelines for imaging in stable patients throughout trauma systems could alleviate this disparity.
Level III retrospective comparative study.
在钝器创伤的儿童中，频繁使用 CT 扫描可能会导致不必要的辐射暴露和费用。最近的文献对在没有明显损伤临床证据的稳定儿童中全身 CT 的效用提出了质疑，但这通常是基于损伤机制来进行的。本研究的目的是根据这些身体部位的损伤严重程度，量化头部、胸部、腹部和骨盆 CT 扫描的使用情况，并评估美国外科医师学院（ACS）儿科创伤中心指定对轻度或无损伤儿童 CT 使用的影响。
我们从 2014 年、2015 年和 2016 年的国家创伤数据库中查询了所有 14 岁及以下的患者。使用损伤严重程度的简明损伤量表（AIS）评分作为代理，我们分析了在每个身体部位中，损伤严重程度较低（AIS 0-2）的患者进行头部、胸部和腹部 CT 扫描的数量，并根据创伤中心的级别指定（ACS I、II、III、独立儿科 I 或 II 以及非 ACS 认证）进行分析。
在因任何原因进入数据库的 257661 名儿童中，总体 CT 使用率为头部 20%、胸部 5%、腹部和骨盆 9%。头部无损伤或轻微损伤的儿童分别有 7%和 46%的时间进行胸部扫描，分别有 3%和 13%的时间进行腹部扫描。对于所有身体部位和所有损伤严重程度级别，一级独立儿科中心的 CT 使用率明显低于其他中心。
对于头部、胸部、腹部和骨盆仅有轻微或无损伤的儿童，CT 扫描率较高。一级独立儿科创伤中心最不可能进行这些研究。在整个创伤系统中，广泛教育和接受针对稳定患者的影像学临床指南，可能会缓解这一差异。
三级回顾性比较研究。
