title: Pediatric trauma care with computed tomography--criteria for CT scanning.
abstract: Trauma centers, trauma management concepts, as well as integration of whole-body computed tomography (CT) reduced mortality significantly. The accuracy of a trauma care algorithm with emergency CT in children was evaluated. Data of 71 children with emergency CT were recorded retrospectively. In addition to epidemiological data admission date, kind of CT scan, mechanism of injury, missed diagnoses, injury severity score (ISS), admission to and time on intensive care unit (ICU), and time of hospitalization were observed. The algorithm for CT scanning was based on mechanism of injury, pattern of injury, and altered vital signs. Sixty-nine percent of the children reached the ER during on-call service hours. A percentage of 32.4 received a whole-body scan and 67.6 % a cranial scan. The mean ER ISS was 9.9 points (1-57). Children have different trauma mechanisms compared to adults. A percentage of 33.8 of the children had relevant trauma related findings in the CT scan. In 2 children, (2.8 %) 3 diagnoses (2.2 %) were initially missed. After reevaluation of the CT data, all diagnoses were identified. Thus, the accuracy of our algorithm in children was 100 %. In children, our algorithm detected all injuries, but only one third of the children had relevant trauma related findings in the CT scan. In order to reduce radiation exposure but preserve the advantages of CT, a new algorithm was developed with more flexibility taking the child's age and mental status more into account as well as clinical findings. The mechanism of injury itself is not anymore an indication for CT scanning.
authors.affiliation: Department of Trauma and Orthopedic Surgery; Westpfalz-Klinikum Kaiserslautern, Medical Faculty Mannheim, University of Heidelberg and University of Mainz, Hellmut-Hartert-Str. 1, D-67655, Kaiserslautern, Germany. mmuhm@westpfalz-klinikum.de.|Medical Faculty Mannheim, University of Heidelberg, Heidelberg, Germany. mmuhm@westpfalz-klinikum.de.
authors.forename: Markus
authors.initials: M
authors.lastname: Muhm
authors.affiliation: Department of Trauma and Orthopedic Surgery; Westpfalz-Klinikum Kaiserslautern, Medical Faculty Mannheim, University of Heidelberg and University of Mainz, Hellmut-Hartert-Str. 1, D-67655, Kaiserslautern, Germany.
authors.forename: Tim
authors.initials: T
authors.lastname: Danko
authors.affiliation: Institute of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Medical Faculty Mannheim, University of Heidelberg, Heidelberg, Germany.
authors.forename: Thomas
authors.initials: T
authors.lastname: Henzler
authors.affiliation: DENIT - German Institute for Emergency Medicine and Information Technology, Fraunhofer Institute for Experimental Software Engineering (IESE), Kaiserslautern, Germany.
authors.forename: Thomas
authors.initials: T
authors.lastname: Luiz
authors.affiliation: Department of Trauma and Orthopedic Surgery; Westpfalz-Klinikum Kaiserslautern, Medical Faculty Mannheim, University of Heidelberg and University of Mainz, Hellmut-Hartert-Str. 1, D-67655, Kaiserslautern, Germany.|Medical Faculty Mannheim, University of Heidelberg, Heidelberg, Germany.
authors.forename: Hartmut
authors.initials: H
authors.lastname: Winkler
authors.affiliation: Department of Trauma and Orthopedic Surgery; Westpfalz-Klinikum Kaiserslautern, Medical Faculty Mannheim, University of Heidelberg and University of Mainz, Hellmut-Hartert-Str. 1, D-67655, Kaiserslautern, Germany.
authors.forename: Thomas
authors.initials: T
authors.lastname: Ruffing
mesh_terms: D000293:Adolescent; D000465:Algorithms; D002648:Child; D002675:Child, Preschool; D003951:Diagnostic Errors / Q000706:statistics & numerical data; D005858:Germany; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D015601:Injury Severity Score; D007362:Intensive Care Units / Q000706:statistics & numerical data; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed / Q000379:methods*; D014193:Trauma Centers; D055986:Vital Signs; D051598:Whole Body Imaging; D014947:Wounds and Injuries / Q000000981:diagnostic imaging*
keywords: Computed tomography; Criteria for CT scanning; Mechanism of injury; Pediatric trauma; Radiation dose reduction