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
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.
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.
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.
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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