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Pediatric trauma at Berkshire Medical Center: Retrospective study on protocol-based use of CT-scans
Hector Melendez-Lopez, Mark Kryskow, Paul Johansen, Michael DiSiena
Berkshire Medical Center, Pittsfield, MA
Background: Injury is the leading cause of death and disability among children and adolescents aged 1-18 in the United States. CT-scans are commonly used to diagnose or rule out injuries in these cases. However, there is a growing concern about the increased risk of cancer associated with the cumulative exposure to radiation.
Methods: Study conducted from August 2021 to 2023, involved trauma patients aged 0-15. Fisher exact test with an alpha 0.05 was used for analysis. Indications for CT-scans were documented based on primary and secondary surveys. Scans were categorized based on their indication and results into four groups: indicated-positive, indicated-negative, not-indicated-positive, and not-indicated-negative.
Results: Out of 79 trauma patients, 56 underwent 184 CT-scans. Of these, 36% were indicated scans, while 64% were non-indicated. Notably, 96% of all non-indicated scans had negative results, with specific rates: head 94%, c-spine 100%, chest 91%, and abdomen/pelvis 100% (p-value 0.0001). In head, 75% of indicated head CT-scans had positive findings. For the abdomen/pelvis, 72% of the scans were indicated regardless of the result (p-value 0.053). In the c-spine, 90% of indicated scans were negative (p-value 0.029), while 100% of indicated chest scans were positive (p-value 0.013).
Conclusion: Pediatric trauma patients with injuries are being identified and appropriately diagnosed but the percentage of not-indicated CT-scans performed is significant. Revision and standardization of protocol-based criteria to evaluate pediatric trauma patients among teams providing care is needed to decrease the exposure to ionizing radiation. The accuracy on recording injuries needs to be addressed for further studies.
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