Lehigh Valley Health Network, Allentown, Pennsylvania.
Division of Bariatric and Trauma Surgery, Lehigh Valley Health Network, Allentown, Pennsylvania.
J Surg Res. 2020 Nov;255:111-117. doi: 10.1016/j.jss.2020.05.051. Epub 2020 Jun 16.
Traumatic brain injury is the leading cause of morbidity and mortality for children in the United States. The aim of this study was to develop and implement a guideline to reduce radiation exposure in the pediatric head injury patient by identifying the patient population where repeat imaging is necessary and to establish rapid brain protocol magnetic resonance imaging as the first-line modality.
A retrospective chart review of trauma patients between 0 and 14 y of age admitted at a pediatric level 2 trauma center was performed between January 2013 and June 2019. The guideline established the appropriateness of repeat scans for patients with Glasgow Coma Scale >13 with clinical neurological deterioration or patients with Glasgow Coma Scale ≤13 and intracranial hemorrhagic lesion on initial head computed tomography (CT).
Our trauma registry included 592 patients during the study period, 415 before implementation and 161 after implementation. A total of 132 patients met inclusion criteria, 116 pre-guideline and 16 post-guideline. The number of patients receiving repeat head CTs significantly decreased from 34.5% to 6.3% (P < 0.02). There was also a significant decrease in the mean number of head CT/patient pre-guideline 1.63 (range 1-7) compared with post-guideline 1.06 (range 1-2) (P < 0.02).
CT head imaging is invaluable in the initial trauma evaluation of pediatric patients. However, it can be overused, and the radiation may lead to long-term deleterious effects. Establishing a head imaging guideline which limits use with clinical criteria can be effective in reducing radiation exposure without missing injuries.
在美国，创伤性脑损伤是儿童发病率和死亡率的主要原因。本研究旨在制定和实施一项指南，通过确定需要重复成像的患者人群，并建立快速脑磁共振成像协议作为一线模式，来减少小儿头部损伤患者的辐射暴露。
对 2013 年 1 月至 2019 年 6 月期间在一家儿科 2 级创伤中心就诊的 0 至 14 岁创伤患者进行回顾性病历审查。该指南确定了格拉斯哥昏迷量表（Glasgow Coma Scale，GCS）评分>13 分且有临床神经恶化或 GCS 评分≤13 分且初始头部计算机断层扫描（CT）显示颅内出血病变的患者重复扫描的适宜性。
在研究期间，我们的创伤登记处包括 592 名患者，其中 415 名在实施前，161 名在实施后。共有 132 名患者符合纳入标准，其中 116 名在指南实施前，16 名在指南实施后。接受重复头部 CT 检查的患者数量从 34.5%显著下降至 6.3%（P<0.02）。在指南实施前，每位患者的头部 CT 检查数量为 1.63（范围 1-7），显著高于指南实施后 1.06（范围 1-2）（P<0.02）。
头部 CT 成像在小儿患者的初始创伤评估中非常有价值。然而，它可能被过度使用，且辐射可能导致长期的有害影响。建立一种限制使用临床标准的头部成像指南，可以在不遗漏损伤的情况下有效减少辐射暴露。
