title: Radiation from CT scans in paediatric trauma patients: Indications, effective dose, and impact on surgical decisions.
abstract: OBJECTIVE
  The purpose of this study was to determine the effective dose of radiation due to computed tomography (CT) scans in paediatric trauma patients at a level 1 Canadian paediatric trauma centre. We also explored the indications and actions taken as a result of these scans.
  
  
  METHODS
  We performed a retrospective review of paediatric trauma patients presenting to our centre from January 1, 2007 to December 31, 2008. All CT scans performed during the initial trauma resuscitation, hospital stay, and 6 months afterwards were included. Effective dose was calculated using the reported dose length product for each scan and conversion factors specific for body region and age of the patient.
  
  
  RESULTS
  157 paediatric trauma patients were identified during the 2-year study period. Mean Injury Severity Score was 22.5 (range 12-75). 133 patients received at least one CT scan. The mean number of scans per patient was 2.6 (range 0-16). Most scans resulted in no further action (56%) or additional imaging (32%). A decision to perform a procedure (2%), surgery (8%), or withdrawal of life support (2%) was less common. The average dose per patient was 13.5mSv, which is 4.5 times the background radiation compared to the general population. CT head was the most commonly performed type of scan and was most likely to be repeated. CT body, defined as a scan of the chest, abdomen, and/or pelvis, was associated with the highest effective dose.
  
  
  CONCLUSIONS
  CT is a significant source of radiation in paediatric trauma patients. Clinicians should carefully consider the indications for each scan, especially when performing non-resuscitation scans. There is a need for evidence-based treatment algorithms to assist clinicians in selecting appropriate imaging for patients with severe multisystem trauma.
authors.affiliation: Division of General Surgery, Schulich School of Medicine and Dentistry, University of Western Ontario, London Health Sciences Centre, London, Ontario, Canada.
authors.forename: Michael H
authors.initials: MH
authors.lastname: Livingston
authors.forename: Ana
authors.initials: A
authors.lastname: Igric
authors.forename: Kelly
authors.initials: K
authors.lastname: Vogt
authors.forename: Neil
authors.initials: N
authors.lastname: Parry
authors.forename: Neil H
authors.initials: NH
authors.lastname: Merritt
mesh_terms: D000293:Adolescent; D000465:Algorithms; D002170:Canada / Q000453:epidemiology; D002648:Child; D002675:Child, Preschool; D002985:Clinical Protocols; D003657:Decision Making; D004307:Dose-Response Relationship, Radiation; D019317:Evidence-Based Medicine; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015601:Injury Severity Score; D008297:Male; D017410:Practice Guidelines as Topic; D011829:Radiation Dosage; D011832:Radiation Injuries / Q000517:prevention & control*; D011874:Radiometry; D012151:Resuscitation / Q000379:methods; D012189:Retrospective Studies; D018570:Risk Assessment; D014057:Tomography, X-Ray Computed / Q000009:adverse effects / Q000379:methods; D014193:Trauma Centers; D014947:Wounds and Injuries / Q000000981:diagnostic imaging* / Q000601:surgery*
keywords: Computed tomography; Effective dose; Paediatric; Radiation; Trauma