From the Department of Surgery, Albany Medical College, Albany, NY.
Albany Medical College, Albany, NY.
Pediatr Emerg Care. 2021 Dec 1;37(12):e1478-e1481. doi: 10.1097/PEC.0000000000002087.
Computerized tomography (CT) scans are the mainstay of diagnostic imaging in blunt trauma. Particularly in pediatric trauma, utilization of CT scans has increased exponentially in recent years. Concerns regarding radiation exposure to this vulnerable population have resulted in increased scrutiny of practice. What is not known is if liberal imaging practices decrease length of stay by eliminating the need for clinical observation, and the impact of false-positive rates from liberal use of CT scanning on clinical outcomes.
Medical records from a nonaccredited pediatric trauma center with a practice of liberal imaging were reviewed over a 2-year period. Total CT scans obtained were recorded, in addition to length of stay, age, and Injury Severity Score (ISS). Rates of clinically significant imaging findings were recorded, as were false positive findings and complications of imaging.
Out of 735 children, 58% underwent CT scanning, and if scanned, received an average of 2.4 studies. Clinically significant findings were documented in 20% of head CTs, 2% of cervical spine CTs, 3.5% of chest CTs, 24% of facial CTs, and 14.7% of abdominal CTs. False-positive findings were found in 1.5% of head CTs, 1.2% of cervical spine CTs, 2.4% of chest CTs, and 2.5% of abdominal CTs. Liberal CT scanning was not associated with decreased length of stay. In contrast, obtaining CT scans on more than 4 body regions was independently predictive of longer length of stay, independent of ISS.
False-positive rates of CT scans for trauma were low in this cohort. However, when scanning the cervical spine or the chest, for every 2 clinically significant findings obtained, there was at least one false positive result, calling into question the practice of liberal imaging of these regions. Liberal utilization of CT scan did not allow for more rapid discharge home, and for more than 4 CTs was independently associated with longer hospital stay.
计算机断层扫描（CT）是钝性创伤诊断成像的主要手段。特别是在儿科创伤中，近年来 CT 扫描的应用呈指数级增长。对这一脆弱人群的辐射暴露的担忧导致了对实践的更严格审查。目前尚不清楚的是，自由成像实践是否通过消除临床观察的需要来缩短住院时间，以及自由使用 CT 扫描对临床结果的假阳性率的影响。
对一家非认证的儿科创伤中心的医疗记录进行了为期两年的回顾性研究，该中心的影像学检查方法较为自由。记录了获得的总 CT 扫描次数，以及住院时间、年龄和损伤严重程度评分（ISS）。记录了有临床意义的影像学发现的发生率，以及假阳性发现和影像学并发症的发生率。
在 735 名儿童中，58%接受了 CT 扫描，如果扫描，平均接受了 2.4 项检查。20%的头部 CT 有临床意义的发现，2%的颈椎 CT 有临床意义的发现，3.5%的胸部 CT 有临床意义的发现，24%的面部 CT 有临床意义的发现，14.7%的腹部 CT 有临床意义的发现。头部 CT 的假阳性率为 1.5%，颈椎 CT 的假阳性率为 1.2%，胸部 CT 的假阳性率为 2.4%，腹部 CT 的假阳性率为 2.5%。自由 CT 扫描与住院时间缩短无关。相反，获得超过 4 个身体部位的 CT 扫描与住院时间延长独立相关，与 ISS 无关。
在本队列中，创伤 CT 扫描的假阳性率较低。然而，当扫描颈椎或胸部时，每获得 2 个有临床意义的发现，就至少有一个假阳性结果，这使得对这些部位进行自由成像的做法受到质疑。自由使用 CT 扫描并不能更快地出院回家，而且超过 4 次 CT 扫描与住院时间延长独立相关。
