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Reduction of Abdominal CT Imaging in Children at Very Low Risk for Intraabdominal Injury in a Canadian Pediatric Trauma Centre
Suzanne Beno, MD; Dorothy McDowall, RN; Daniel Rosenfield, MD; Michael Aquino, MD; Paul Wales, MD, MSc; Tania Principi, MD, MSc
The Hospital for Sick Children, Toronto, ON, Canada

BACKGROUND
Data indicates 17-25% of children receiving abdominal CT imaging after trauma are at very low risk for intraabdominal injury (IAI), with expected yields of 0.1%. Unnecessary imaging exposes children to harm. We aimed to reduce abdominal CT scans in pediatric trauma patients at very low risk of IAI by 20% utilizing a dedicated Diagnostic Imaging algorithm.

METHODS
Setting: Pediatric Level 1 Trauma Centre

Design: Retrospective record review (for baseline audit) followed by prospective cohort observation after implementation of revised CT requisition.

Patients: Pediatric trauma activations receiving abdominal CT scans from December 11, 2017 April 15, 2018.

Measures: Main outcome was abdominal CT scans in patients at very low risk of IAI, defined by injury severity score <= 8 and/or by specified decision rule. CT scans ordered within 24hr of admission, return visits within 72 hr, and admissions to hospital with newly diagnosed IAI were balancing measures for missed injury.

RESULTS
Pre-intervention, 103/187 (55.1%) of trauma patients in 2016/17 received abdominal CT scans, of which 33/103 (32.0%) were suggested to be low risk for IAI with injury severity score (ISS) <= 8. Post-intervention, the proportion of abdominal CT scans in all trauma patients and those at very low risk for IAI decreased to 22/53 (41.5%) and 1/22 (4.5%) respectively, without any missed injuries.

CONCLUSIONS
This quality improvement initiative resulted in a 25% reduction in abdominal CT imaging in pediatric trauma patients without missed injuries. This initiative has reduced unnecessary testing and clinically significant ionizing radiation in a vulnerable population.


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