Application Of A Thoracic Ct Decision Rule In The Evaluation Of Injured Children: A Quality Improvement Initiative
*Katie Downie1, Alicia McIntire1, Joseph Tobias2, *Sanjay Krishnaswami3, *Mubeen Jafri2
1Legacy Emanuel/Randall Children's Hospital, Portland, OR;2OHSU, Portland, OR;3OSHU, Portland, OR
Purpose: A protocol was implemented to guide utilization of thoracic computed tomography(TCT) in the evaluation of pediatric blunt trauma.Significance: Differences in injury patterns in children suggest that life-threatening injuries of the chest are rare. Radiation exposure from computed tomography increases cancer risk in children. Two large retrospective pediatric studies have demonstrated that TCT can be reserved for patients based on mechanism of injury and abnormal findings on chest X-ray(CXR).Methods: A protocol for TCT utilization in pediatric blunt trauma was implemented using a PDSA cycle at our Level I pediatric trauma center, reserving TCT for patients with 1) mediastinal widening on CXR or 2) vehicle-related mechanism and abnormal CXR. We modified our resuscitation order-set to limit default imaging bundles. The medical record and trauma registry data were reviewed for all pediatric blunt trauma patients(<18 years old) over a 30-month study period before and after protocol implementation, allowing for a six-month implementation period.Results: During the study period, 1,056 blunt trauma patients were evaluated with a median ISS of 5(0-58). There were no significant demographic differences between patients before and after protocol implementation. TCT utilization significantly decreased after implementation of the protocol[26.4% (129/488) to 12.7% (72/568)(p<0.05)] with no increase in clinically significant missed injuries. Protocol compliance was 67.6%.Conclusions: Application of decision rules can safely limit ionizing radiation in injured children. Further limitations to TCT utilization may be safe and warrant continued study due to the rarity of significant injuries.
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