The use of whole body computed tomography scans in pediatric trauma patients: Are there differences among adults and pediatric centers?

Viraj Pandit, Maria Michailidou, Peter Rhee, Bardiya Zangbar, Narong Kulvatunyou, Mazhar Khalil, Terence OKeeffe, Ansab Haider, Lynn Gries, Bellal Joseph

Research output: Contribution to journalArticle

8 Citations (Scopus)

Abstract

Introduction Whole body CT (WBCT) scan is known to be associated with significant radiation risk especially in pediatric trauma patients. The aim of this study was to assess the use WBCT scan across trauma centers for the management of pediatric trauma patients. Methods We performed a two year (2011-2012) retrospective analysis of the National Trauma Data Bank. Pediatric (age ≤ 18 years) trauma patients managed in level I or II adult or pediatric trauma centers with a head, neck, thoracic, or abdominal CT scan were included. WBCT scan was defined as CT scan of the head, neck, thorax, and abdomen. Patients were stratified into two groups: patients managed in adult centers and patients managed in designated pediatric centers. Outcome measure was use of WBCT. Multivariate logistic regression analysis was performed. Results A total of 30,667 pediatric trauma patients were included of which; 38.3% (n = 11,748) were managed in designated pediatric centers. 26.1% (n = 8013) patients received a WBCT. The use of WBCT scan was significantly higher in adult trauma centers in comparison to pediatric centers (31.4% vs. 17.6%, p = 0.001). There was no difference in mortality rate between the two groups (2.2% vs. 2.1%, p = 0.37). After adjusting for all confounding factors, pediatric patients managed in adult centers were 1.8 times more likely to receive a WBCT compared to patients managed in pediatric centers (OR [95% CI]: 1.8 [1.3-2.1], p = 0.001). Conclusions Variability exists in the use of WBCT scan across trauma centers with no difference in patient outcomes. Pediatric patients managed in adult trauma centers were more likely to be managed with WBCT, increasing their risk for radiation without a difference in outcomes. Establishing guidelines for minimizing the use of WBCT across centers is warranted.

Original languageEnglish (US)
Pages (from-to)649-653
Number of pages5
JournalJournal of Pediatric Surgery
Volume51
Issue number4
DOIs
StatePublished - Apr 1 2016
Externally publishedYes

Fingerprint

Tomography
Pediatrics
Wounds and Injuries
Whole Body Imaging
Trauma Centers
Neck
Thorax
Head
Radiation
Abdomen
Logistic Models
Regression Analysis
Outcome Assessment (Health Care)
Databases
Guidelines
Mortality

Keywords

  • Radiation risk in pediatrics
  • Scan utilization by trauma centers
  • Scanning differences in adult and pediatric centers
  • Whole body CT scan in pediatrics

ASJC Scopus subject areas

  • Surgery
  • Pediatrics, Perinatology, and Child Health

Cite this

The use of whole body computed tomography scans in pediatric trauma patients : Are there differences among adults and pediatric centers? / Pandit, Viraj; Michailidou, Maria; Rhee, Peter; Zangbar, Bardiya; Kulvatunyou, Narong; Khalil, Mazhar; OKeeffe, Terence; Haider, Ansab; Gries, Lynn; Joseph, Bellal.

In: Journal of Pediatric Surgery, Vol. 51, No. 4, 01.04.2016, p. 649-653.

Research output: Contribution to journalArticle

Pandit, V, Michailidou, M, Rhee, P, Zangbar, B, Kulvatunyou, N, Khalil, M, OKeeffe, T, Haider, A, Gries, L & Joseph, B 2016, 'The use of whole body computed tomography scans in pediatric trauma patients: Are there differences among adults and pediatric centers?', Journal of Pediatric Surgery, vol. 51, no. 4, pp. 649-653. https://doi.org/10.1016/j.jpedsurg.2015.12.002
Pandit, Viraj ; Michailidou, Maria ; Rhee, Peter ; Zangbar, Bardiya ; Kulvatunyou, Narong ; Khalil, Mazhar ; OKeeffe, Terence ; Haider, Ansab ; Gries, Lynn ; Joseph, Bellal. / The use of whole body computed tomography scans in pediatric trauma patients : Are there differences among adults and pediatric centers?. In: Journal of Pediatric Surgery. 2016 ; Vol. 51, No. 4. pp. 649-653.
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abstract = "Introduction Whole body CT (WBCT) scan is known to be associated with significant radiation risk especially in pediatric trauma patients. The aim of this study was to assess the use WBCT scan across trauma centers for the management of pediatric trauma patients. Methods We performed a two year (2011-2012) retrospective analysis of the National Trauma Data Bank. Pediatric (age ≤ 18 years) trauma patients managed in level I or II adult or pediatric trauma centers with a head, neck, thoracic, or abdominal CT scan were included. WBCT scan was defined as CT scan of the head, neck, thorax, and abdomen. Patients were stratified into two groups: patients managed in adult centers and patients managed in designated pediatric centers. Outcome measure was use of WBCT. Multivariate logistic regression analysis was performed. Results A total of 30,667 pediatric trauma patients were included of which; 38.3{\%} (n = 11,748) were managed in designated pediatric centers. 26.1{\%} (n = 8013) patients received a WBCT. The use of WBCT scan was significantly higher in adult trauma centers in comparison to pediatric centers (31.4{\%} vs. 17.6{\%}, p = 0.001). There was no difference in mortality rate between the two groups (2.2{\%} vs. 2.1{\%}, p = 0.37). After adjusting for all confounding factors, pediatric patients managed in adult centers were 1.8 times more likely to receive a WBCT compared to patients managed in pediatric centers (OR [95{\%} CI]: 1.8 [1.3-2.1], p = 0.001). Conclusions Variability exists in the use of WBCT scan across trauma centers with no difference in patient outcomes. Pediatric patients managed in adult trauma centers were more likely to be managed with WBCT, increasing their risk for radiation without a difference in outcomes. Establishing guidelines for minimizing the use of WBCT across centers is warranted.",
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T2 - Are there differences among adults and pediatric centers?

AU - Pandit, Viraj

AU - Michailidou, Maria

AU - Rhee, Peter

AU - Zangbar, Bardiya

AU - Kulvatunyou, Narong

AU - Khalil, Mazhar

AU - OKeeffe, Terence

AU - Haider, Ansab

AU - Gries, Lynn

AU - Joseph, Bellal

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N2 - Introduction Whole body CT (WBCT) scan is known to be associated with significant radiation risk especially in pediatric trauma patients. The aim of this study was to assess the use WBCT scan across trauma centers for the management of pediatric trauma patients. Methods We performed a two year (2011-2012) retrospective analysis of the National Trauma Data Bank. Pediatric (age ≤ 18 years) trauma patients managed in level I or II adult or pediatric trauma centers with a head, neck, thoracic, or abdominal CT scan were included. WBCT scan was defined as CT scan of the head, neck, thorax, and abdomen. Patients were stratified into two groups: patients managed in adult centers and patients managed in designated pediatric centers. Outcome measure was use of WBCT. Multivariate logistic regression analysis was performed. Results A total of 30,667 pediatric trauma patients were included of which; 38.3% (n = 11,748) were managed in designated pediatric centers. 26.1% (n = 8013) patients received a WBCT. The use of WBCT scan was significantly higher in adult trauma centers in comparison to pediatric centers (31.4% vs. 17.6%, p = 0.001). There was no difference in mortality rate between the two groups (2.2% vs. 2.1%, p = 0.37). After adjusting for all confounding factors, pediatric patients managed in adult centers were 1.8 times more likely to receive a WBCT compared to patients managed in pediatric centers (OR [95% CI]: 1.8 [1.3-2.1], p = 0.001). Conclusions Variability exists in the use of WBCT scan across trauma centers with no difference in patient outcomes. Pediatric patients managed in adult trauma centers were more likely to be managed with WBCT, increasing their risk for radiation without a difference in outcomes. Establishing guidelines for minimizing the use of WBCT across centers is warranted.

AB - Introduction Whole body CT (WBCT) scan is known to be associated with significant radiation risk especially in pediatric trauma patients. The aim of this study was to assess the use WBCT scan across trauma centers for the management of pediatric trauma patients. Methods We performed a two year (2011-2012) retrospective analysis of the National Trauma Data Bank. Pediatric (age ≤ 18 years) trauma patients managed in level I or II adult or pediatric trauma centers with a head, neck, thoracic, or abdominal CT scan were included. WBCT scan was defined as CT scan of the head, neck, thorax, and abdomen. Patients were stratified into two groups: patients managed in adult centers and patients managed in designated pediatric centers. Outcome measure was use of WBCT. Multivariate logistic regression analysis was performed. Results A total of 30,667 pediatric trauma patients were included of which; 38.3% (n = 11,748) were managed in designated pediatric centers. 26.1% (n = 8013) patients received a WBCT. The use of WBCT scan was significantly higher in adult trauma centers in comparison to pediatric centers (31.4% vs. 17.6%, p = 0.001). There was no difference in mortality rate between the two groups (2.2% vs. 2.1%, p = 0.37). After adjusting for all confounding factors, pediatric patients managed in adult centers were 1.8 times more likely to receive a WBCT compared to patients managed in pediatric centers (OR [95% CI]: 1.8 [1.3-2.1], p = 0.001). Conclusions Variability exists in the use of WBCT scan across trauma centers with no difference in patient outcomes. Pediatric patients managed in adult trauma centers were more likely to be managed with WBCT, increasing their risk for radiation without a difference in outcomes. Establishing guidelines for minimizing the use of WBCT across centers is warranted.

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KW - Scanning differences in adult and pediatric centers

KW - Whole body CT scan in pediatrics

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