title: A Portable CT Scanner in the Pediatric Intensive Care Unit Decreases Transfer-Associated Adverse Events and Staff Disruption.
abstract: BACKGROUND
  Computerized tomography (CT) is an important diagnostic tool in the management of critically ill children, especially those with neurosurgical problems such as traumatic brain injury. Traditionally, such scans require transfer to the radiology department (RD) at times of extreme physiological instability, such as incipient cerebral herniation, and exposes children with actual, or potential, spinal injuries to the risks of transfer. Moving children from pediatric intensive care (PIC), often overnight, also depletes units of senior staff. Portable CT (PCT) scanning offers a solution to this problem, and we assessed patient stability and staff time occupied during urgent CT scans before and after the introduction of a PCT scanner (CereTom(®)) in a regional neurosurgical pediatric intensive care unit (PICU).
  
  
  METHODS
  Prospective observational study of ventilated children in the PICU requiring urgent CT of the head to limit secondary brain injury. Data was collected for three months prior to, and for the same period after, the introduction of PCT on a questionnaire designed to assess physiological variables, PICU interventions, and staff time, which was completed immediately post scanning.
  
  
  RESULTS
  Eight children had urgent CT head scan in the RD during the first 3 months and ten PCT in the second 6 months. The patients transferred to the RD required medical intervention because of cardio-respiratory instability or fluctuating intracranial pressure in nearly every patient and clearly increased the strain on staff resources. None of those patients undergoing PCT had untoward events and staff resources were far less impacted upon.
  
  
  CONCLUSIONS
  PCT scanning is safe for unstable neurosurgical patients who need urgent diagnostic head CT, reducing the risks associated with transfer and the depletion of staff provision to the other children in the PICU. While this study did not specifically address image quality, all images were diagnostic regarding the indication for scanning.
authors.affiliation: Paediatric and Neonatal Intensive Care Unit, Institute of Child Health and Great Ormond Street Hospital for Children, London, UK. agraws1@gosh.nhs.uk.|Paediatric and Neonatal Intensive Care Unit, Institute of Child Health and Great Ormond Street Hospital for Children, WC1N 3JH, London, UK. agraws1@gosh.nhs.uk.
authors.forename: Shruti
authors.initials: S
authors.lastname: Agrawal
authors.affiliation: Paediatric and Neonatal Intensive Care Unit, Institute of Child Health and Great Ormond Street Hospital for Children, London, UK.
authors.forename: Sara-Louise
authors.initials: SL
authors.lastname: Hulme
authors.affiliation: Department of Paediatric Neurosurgery, Institute of Child Health and Great Ormond Street Hospital for Children, London, UK.
authors.forename: Richard
authors.initials: R
authors.lastname: Hayward
authors.affiliation: Paediatric and Neonatal Intensive Care Unit, Institute of Child Health and Great Ormond Street Hospital for Children, London, UK.
authors.forename: Joe
authors.initials: J
authors.lastname: Brierley
keywords: Head injury; Neurosurgery; Pediatrics; Portable CT imaging; Trauma
references.citation: Pediatr Neurosurg. 2000 Jan;32(1):37-43
references.pmid: 10765137
references.citation: Br J Radiol. 1999 Jul;72 (859):631-6
references.pmid: 10624318
references.citation: Lancet. 1990 Feb 10;335(8685):327-30
references.pmid: 1967776
references.citation: Neurosurgery. 1998 Jun;42(6):1304-10; discussion 1310-1
references.pmid: 9632189
references.citation: J Trauma. 2007 Jun;62(6):1339-44; discussion 1344-5
references.pmid: 17563645
references.citation: Crit Care Med. 1990 Mar;18(3):278-81
references.pmid: 2302952
references.citation: Radiol Manage. 2008 Mar-Apr;30(2):50-4
references.pmid: 18431942
references.citation: Pediatr Crit Care Med. 2001 Oct;2(4):346-8
references.pmid: 12793939
references.citation: J Neurosurg. 2000 Sep;93(3):432-6
references.pmid: 10969941
references.citation: Neurosurg Rev. 1998;21(2-3):98-101
references.pmid: 9795941
references.citation: Acad Emerg Med. 2007 Jun;14(6):574-7
references.pmid: 17535981
references.citation: Crit Care Med. 2000 Dec;28(12):3808-13
references.pmid: 11153618
references.citation: Crit Care Med. 1995 Sep;23(9):1588-95
references.pmid: 7664562
references.citation: Crit Care Med. 2006 Apr;34(4):958-63; quiz 971
references.pmid: 16484912