Purpose or Case Report: Computed tomography (CT) imaging protocols and prescribing practices vary across institutions. Pediatric trauma patients treated at a pediatric trauma center (PTC) may receive less radiation if their CT imaging is performed at a PTC rather than at non-PTCs prior to transfer. The objective of the study was to determine differences in radiation exposure from CT imaging in pediatric trauma patients initially treated at a PTC center compared to non-PTCs.
Methods & Materials: This was a retrospective observational analysis of trauma-related encounters at a Level I PTC. The participants were patients <18 years old who received a CT scan from 1/2013-8/2015 for trauma-related encounters. Patients were included if they had a CT scan either performed at our PTC, or sent into the PTC from the referring institution. Radiation doses from CT scans were estimated using proprietary software and compared between scans performed at our PTC and non-PTCs. Patient characteristics were compared using propensity score weighted median regression. An image quality score was used to assess diagnostic adequacy for each study.
Results: Of 3530 CT scans, 3021 were performed at our PTC and 509 at a non-PTC. Patients imaged at non-PTCs were older (median age 10 versus 6 years), more frequently white (82.5 versus 66.9%), and had higher injury severity (with new injury severity score>15 in 16.8 versus 11.0%) (all p<0.05). Patients imaged at non-PTCs were more likely to have a neck CT (29.0 versus 7.3%, p<0.001) and chest CT (8.3 versus 2.7%, p<0.001), but less likely to have an abdomen/pelvis CT (19.5 versus 27.9%, p=0.001) (Table 1). After propensity weighting, rates of CT scanning were higher at non-PTCs with patients imaged at non-PTCs receiving higher cumulative radiation exposure (median effective dose 2.36 versus 1.57 mSv, p<0.001) with higher radiation exposure to each body region imaged (17% more for head , 191% for neck, 81% more for chest, and 33% for abdomen/pelvis) (Table).
Conclusions: Pediatric trauma patients imaged at a PTC receive a lower radiation burden from CT imaging than patients initially imaged at adult institutions prior to transfer. Broader adoption of pediatric dosing protocols or deferring non-critical CT scans until transfer to a PTC may mitigate these disparities.