Repeat computed tomography scans after pediatric trauma: results of an institutional effort to minimize radiation exposure.
BACKGROUND
Many pediatric trauma patients are initially evaluated at non-pediatric, non-trauma centers where they undergo CT prior to transfer to a pediatric trauma center. The purpose of this study is to quantify the number of repeat CT and assess the risk of delayed or missed injuries.


METHODS
The institutional pediatric trauma registry was queried for patients evaluated from January 2001 to March 2012. All patients who underwent repeat CT within 24 h after transfer were included. General admission, demographic, and outcome data were analyzed.


RESULTS
A total of 6041 patients were transferred from a referring hospital after undergoing CT scans. Five percent of patients underwent repeat CT with a mean age of 6.3 ± 5.7 years. Patients who underwent repeat CT scans had significantly higher Injury Severity Scores and lower Glasgow Coma Scale. CT head was the most commonly repeated. Comparing results of referring CT scans to repeated scans, there was good agreement between results for head CT (κ = 0.69) and moderate agreement for abdominopelvic CT (κ = 0.59). The overall incidence of delayed diagnosis of injuries was 0.7%.


CONCLUSIONS
The low incidence of missed or delayed injuries justifies limiting additional radiation exposure to pediatric trauma patients based on clinical status.
Division of Pediatric Surgery, All Children's Hospital Johns Hopkins Medicine, Outpatient Care Center, 601 5th Street South, Dept 70-6600, 3rd Floor, Saint Petersburg, FL, 33701, USA. sfarach@comcast.net.
Sandra M
SM
Farach
Division of Pediatric Surgery, All Children's Hospital Johns Hopkins Medicine, Outpatient Care Center, 601 5th Street South, Dept 70-6600, 3rd Floor, Saint Petersburg, FL, 33701, USA. paul.danielson@jhmi.edu.
Paul D
PD
Danielson
Clinical and Translational Research Organization, All Children's Hospital Johns Hopkins Medicine, 501 6th Avenue South, Saint Petersburg, FL, 3701, USA. ernest.amankwah@jhmi.edu.
Ernest K
EK
Amankwah
Division of Pediatric Surgery, All Children's Hospital Johns Hopkins Medicine, Outpatient Care Center, 601 5th Street South, Dept 70-6600, 3rd Floor, Saint Petersburg, FL, 33701, USA. nicole.chandler@jhmi.edu.
Nicole M
NM
Chandler
D002648:Child; D005260:Female; D015600:Glasgow Coma Scale; D006801:Humans; D015601:Injury Severity Score; D008297:Male; D000069079:Radiation Exposure / Q000706:statistics & numerical data*; D012017:Referral and Consultation / Q000706:statistics & numerical data; D014057:Tomography, X-Ray Computed; D014193:Trauma Centers / Q000706:statistics & numerical data; D014947:Wounds and Injuries / Q000000981:diagnostic imaging*
Computed tomography; Pediatric; Repeat scan; Trauma