Are CT scans obtained at referring institutions justified prior to transfer to a pediatric trauma center?
OBJECTIVE
To assess whether pediatric trauma patients initially evaluated at referring institutions met Massachusetts statewide trauma field triage criteria for stabilization and immediate transfer to a Pediatric Trauma Center (PTC) without pre-transfer CT imaging.


METHODS
A 3-year retrospective cohort study was completed at our level 1 PTC. Patients with CT imaging at referring institutions were classified according to a triage scheme based on Massachusetts statewide trauma field triage criteria. Demographic data and injury profile characteristics were abstracted from patient medical records and our pediatric trauma registry.


RESULTS
A total of 262 patients with 413 CT scans were reviewed from 2008 to 2011. 172 patients scanned (66%, 95% CI: 60%, 71%) met criteria for immediate transfer to a pediatric trauma center. Notably, 110 scans (27% of the total performed at referring institutions) were duplicated within four hours upon arrival to our PTC. GCS score <14 (45%) was the most common requirement for transfer, and CT scan of the head was the most frequent scan obtained (53%).


CONCLUSIONS
The majority of pediatric trauma patients were subjected to CT scans at referring institutions despite meeting Massachusetts trauma triage guidelines that call for stabilization and immediate transfer to a pediatric trauma center without any CT imaging.
Department of Pediatric Surgery, Floating Hospital for Children, Tufts Medical Center, Boston, MA.
Leo Andrew
LA
Benedict
Tufts Clinical and Translational Science Institute, Boston, MA 02111.
Jessica K
JK
Paulus
Department of Pediatric Surgery, Floating Hospital for Children, Tufts Medical Center, Boston, MA.
Leslie
L
Rideout
Department of Pediatric Surgery, Floating Hospital for Children, Tufts Medical Center, Boston, MA. Electronic address: wchwals@tuftsmedicalcenter.org.
Walter J
WJ
Chwals
D000058:Accidental Falls / Q000706:statistics & numerical data; D000063:Accidents, Traffic / Q000706:statistics & numerical data; D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D006259:Craniocerebral Trauma / Q000000981:diagnostic imaging; D003955:Diagnostic Tests, Routine / Q000706:statistics & numerical data; D005260:Female; D015600:Glasgow Coma Scale; D019983:Guideline Adherence; D006776:Hospitals, Pediatric; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008404:Massachusetts; D010360:Patient Transfer / Q000592:standards; D017410:Practice Guidelines as Topic; D012017:Referral and Consultation; D062606:Tertiary Care Centers; D014057:Tomography, X-Ray Computed / Q000706:statistics & numerical data*; D014193:Trauma Centers; D014218:Triage; D019564:Unnecessary Procedures / Q000706:statistics & numerical data*; D014947:Wounds and Injuries / Q000000981:diagnostic imaging*; D055815:Young Adult
Computed tomography; Pediatric trauma; Transfer guidelines