Implementation of a CT scan practice guideline for pediatric trauma patients reduces unnecessary scans without impacting outcomes

Patrick R. McGrew MD, University of Nevada, Las Vegas
Paul J. Chestovich MD, University of Nevada, Las Vegas
Jay D. Fisher MD
Deborah A. Kuhls MD, University of Nevada, Las Vegas
Douglas R. Fraser MD, University of Nevada, Las Vegas
Purvi P. Patel MD
Chad W. Katona MD
Syed Saquib MD, University of Nevada, Las Vegas
John J. Fildes MD, University of Nevada, Las Vegas


INTRODUCTION Computed tomography (CT) scans are useful in the evaluation of trauma patients, but are costly and pose risks from ionizing radiation in children. Recent literature has demonstrated the use of CT scan guidelines in the management of pediatric trauma. The study objective is to review our treatment of pediatric blunt trauma patients and evaluate CT use before and after CT-guideline implementation. METHODS Our Pediatric Level 2 Trauma Center (TC) implemented a CT scan practice guideline for pediatric trauma patients in March 2014. The guideline recommended for or against CT of the head and abdomen/pelvis using published criteria from the Pediatric Emergency Care and Research Network. There was no chest CT guideline. We reviewed all pediatric trauma patients for CT scans obtained during initial evaluation before and after guideline implementation, excluding inpatient scans. The Trauma Registry Database was queried to include all pediatric (age < 15) trauma patients seen in our TC from 2010 to 2016, excluding penetrating mechanism and deaths in the TC. Scans were considered positive if organ injury was detected. Primary outcome was the proportion of patients undergoing CT and percent positive CTs. Secondary outcomes were hospital length of stay, readmissions, and mortality. Categorical and continuous variables were analyzed with χ 2 and Wilcoxon rank-sum tests, respectively. p < 0.05 was considered significant. RESULTS We identified 1,934 patients: 1,106 pre- and 828 post-guideline. Absolute reductions in head, chest, and abdomen/pelvis CT scans were 17.7%, 11.5%, and 18.8%, respectively (p < 0.001). Percent positive head CTs were equivalent, but percent positive chest and abdomen CT increased after implementation. Secondary outcomes were unchanged. CONCLUSIONS Implementation of a pediatric CT guideline significantly decreases CT use, reducing the radiation exposure without a difference in outcome. Trauma centers treating pediatric patients should adopt similar guidelines to decrease unnecessary CT scans in children. LEVEL OF EVIDENCE Therapeutic study, level IV.