title: Computed tomography before transfer to a level I pediatric trauma center risks duplication with associated increased radiation exposure.
abstract: BACKGROUND
  Community hospitals commonly obtain computed tomographic (CT) imaging of pediatric trauma patients before triaging to a level I pediatric trauma center (PTC). This practice potentially increases radiation exposure when imaging must be duplicated after transfer.
  
  
  METHODS
  A retrospective review of our level 1 PTC registry from January 1, 2004, to December 31, 2006, was conducted. Level I and II trauma patients were grouped based on whether they had undergone outside CT examination (head and/or abdomen) at a referring hospital (group 1) or received initial CT examination at our institution (group 2). Subgroups were analyzed based on whether duplicate CT examination was required at our PTC (Fischer's Exact test).
  
  
  RESULTS
  A duplicate CT scan (within 4 hours of transfer) was required in 91% (30/33) of group 1 transfer patients, whereas no group 2 patient required a duplicate scan (0/55; P < .0001). There was no significant difference within the groups for weight, age, or intensive care unit length of stay.
  
  
  CONCLUSIONS
  A significant number of pediatric trauma patients who receive CT scans at referring hospitals before transfer to our level I PTC require duplicate scans of the same anatomical field(s) after transfer, exposing them to increase potential clinical risk and cost.
authors.affiliation: Division of Pediatric Surgery, Rainbow Babies and Children's Hospital, Case Western Reserve University School of Medicine, Cleveland, Ohio 44106, USA. walter.chwals@case.edu
authors.forename: Walter J
authors.initials: WJ
authors.lastname: Chwals
authors.forename: Ann V
authors.initials: AV
authors.lastname: Robinson
authors.forename: Carlos J
authors.initials: CJ
authors.lastname: Sivit
authors.forename: Diya
authors.initials: D
authors.lastname: Alaedeen
authors.forename: Ellen
authors.initials: E
authors.lastname: Fitzenrider
authors.forename: Laura
authors.initials: L
authors.lastname: Cizmar
mesh_terms: D000007:Abdominal Injuries / Q000000981:diagnostic imaging* / Q000453:epidemiology; D002648:Child; D002675:Child, Preschool; D016250:Compact Disks; D006259:Craniocerebral Trauma / Q000000981:diagnostic imaging* / Q000453:epidemiology; D004868:Equipment Failure; D005260:Female; D005568:Forms and Records Control; D015600:Glasgow Coma Scale; D006764:Hospitals, Community / Q000706:statistics & numerical data; D006776:Hospitals, Pediatric / Q000706:statistics & numerical data; D006801:Humans; D015278:Intensive Care Units, Pediatric / Q000706:statistics & numerical data; D008297:Male; D010360:Patient Transfer; D011829:Radiation Dosage; D011873:Radiology Information Systems; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed / Q000009:adverse effects / Q000592:standards / Q000706:statistics & numerical data*; D014193:Trauma Centers / Q000706:statistics & numerical data; D015599:Trauma Severity Indices; D019564:Unnecessary Procedures