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The Impact of a Web-Based Image Repository on Repeat Computed Tomography Scans among Children Transferred to a Level I Pediatric Trauma Center
Rosemary Nabaweesi, DrPH, MBChB1,2, Raghu H. Ramakrishnaiah, MD1, Mary E. Aitken, MD, MPH 1,2, Mallikarjuna R. Rettiganti, PhD1,2, Chunqiao Luo, MS1,2, Charles P. Glasier, MD1, Robert T. Maxson, MD, FAAP1, Phillip J. Kenney, MD1, James M. Robbins, PhD1, 2. 1University of Arkansas for Medical Sciences, Little Rock, AR, USA, 2Arkansas Children's Research Institute, Little Rock, AR, USA.

Background: Although overall computed tomography (CT) utilization rates have plateaued recently, CT scans related to traumatic brain injuries have been on the rise, in part due to increased awareness of sports-related concussions. CT diagnostic evaluation is ubiquitous in injured children's assessment. Repeat CT scans, common among children transferred to trauma centers, are associated with increased healthcare costs and unnecessary medical radiation exposure. Long-term cancer risks are 2-3 times higher in children than adults are. Centralized image repositories, developed for providers to have secure access to all images, have the potential to reduce repeat imaging.

Study Aim: To determine if use of a statewide web-based image repository (WBIR) results in reduced repeat imaging among transferred pediatric trauma patients.

Methods: The WBIR, part of the new statewide trauma system presented a natural experiment setting for this study. Injured children younger than 18 years who received a CT scan prior to the pediatric trauma center (PTC) transfer during CY 2010 and CY 2013 were included.

Results: 254 and 233 children were managed in 2010 and 2013 with a mean age of 8 (SD=5.4 years). Head CTs accounted for 46% of all CT scans. The odds of receiving a repeat CT scan were 51% less likely following WBIR establishment (OR 0.49, p=0.005). The mean head CT scan effective dose ranged from 1.2-1.8 at PTC and 2.7-3.8 milliSieverts at transferring facilities.

Conclusions: Adoption of a WBIR lowered the likelihood of children undergoing repeat imaging, with potential reduction in radiation exposure and healthcare expenditures.

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