title: Quality of pediatric abdominal CT scans performed at a dedicated children's hospital and its referring institutions: a multifactorial evaluation.
abstract: BACKGROUND
  Pediatric patients requiring transfer to a dedicated children's hospital from an outside institution may undergo CT imaging as part of their evaluation. Whether this imaging is performed prior to or after transfer has been shown to impact the radiation dose imparted to the patient. Other quality variables could also be affected by the pediatric experience and expertise of the scanning institution.
  
  
  OBJECTIVE
  To identify differences in quality between abdominal CT scans and reports performed at a dedicated children's hospital, and those performed at referring institutions.
  
  
  METHODS
  Fifty consecutive pediatric abdominal CT scans performed at outside institutions were matched (for age, gender and indication) with 50 CT scans performed at a dedicated freestanding children's hospital. We analyzed the scans for technical parameters, report findings, correlation with final clinical diagnosis, and clinical utility. Technical evaluation included use of intravenous and oral contrast agents, anatomical coverage, number of scan phases and size-specific dose estimate (SSDE) for each scan. Outside institution scans were re-reported when the child was admitted to the children's hospital; they were also re-interpreted for this study by children's hospital radiologists who were provided with only the referral information given in the outside institution's report. Anonymized original outside institutional reports and children's hospital admission re-reports were analyzed by two emergency medicine physicians for ease of understanding, degree to which the clinical question was answered, and level of confidence in the report.
  
  
  RESULTS
  Mean SSDE was lower (8.68) for children's hospital scans, as compared to outside institution scans (13.29, P = 0.03). Concordance with final clinical diagnosis was significantly lower for original outside institution reports (38/48, 79%) than for both the admission and study children's hospital reports (48/50, 96%; P = 0.005). Children's hospital admission reports were rated higher than outside institution reports for completeness, ease of understanding, answering of clinical question, and level of confidence of the report (P < 0.001).
  
  
  CONCLUSIONS
  Pediatric abdominal CT scans performed and interpreted at a dedicated children's hospital are associated with higher technical quality, lower radiation dose and a more clinically useful report than those performed at referring institutions.
authors.affiliation: Department of Radiology, Boston Children's Hospital, 300 Longwood Ave., Boston, MA, 02115, USA. aislingsnow@gmail.com.|Department of Radiology, Our Lady's Children's Hospital, Crumlin, Dublin, Ireland. aislingsnow@gmail.com.
authors.forename: Aisling
authors.identifier: http://orcid.org/0000-0002-6406-6215
authors.initials: A
authors.lastname: Snow
authors.affiliation: Program for Patient Safety and Quality, Boston Children's Hospital, Boston, MA, USA.
authors.forename: Carly E
authors.initials: CE
authors.lastname: Milliren
authors.affiliation: Program for Patient Safety and Quality, Boston Children's Hospital, Boston, MA, USA.
authors.forename: Dionne A
authors.initials: DA
authors.lastname: Graham
authors.affiliation: Department of Radiology, Boston Children's Hospital, 300 Longwood Ave., Boston, MA, 02115, USA.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Callahan
authors.affiliation: Department of Radiology, Boston Children's Hospital, 300 Longwood Ave., Boston, MA, 02115, USA.
authors.forename: Robert D
authors.initials: RD
authors.lastname: MacDougall
authors.affiliation: Department of Radiology, Boston Children's Hospital, 300 Longwood Ave., Boston, MA, 02115, USA.
authors.forename: Richard L
authors.initials: RL
authors.lastname: Robertson
authors.affiliation: Department of Radiology, Boston Children's Hospital, 300 Longwood Ave., Boston, MA, 02115, USA.
authors.forename: George A
authors.initials: GA
authors.lastname: Taylor
mesh_terms: D002648:Child; D005260:Female; D006776:Hospitals, Pediatric; D006801:Humans; D008297:Male; D011785:Quality Assurance, Health Care / Q000706:statistics & numerical data*; D011860:Radiography, Abdominal / Q000592:standards*; D012017:Referral and Consultation; D014057:Tomography, X-Ray Computed / Q000592:standards*
keywords: Abdomen; Appendicitis; Children; Computed tomography; Quality; Radiation; Trauma