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  • br Methods We identified children

    2022-09-17


    Methods: We identified children age 18 years with blunt injury AIS 2 treated from 2010 to 2013 at 130 U.S trauma centers participating in the Trauma Quality Improvement Program. CT rates were compared across center types using Chi-square analysis. Stratified analyses in children with varying injury severity, mechanism, and age were performed. We estimated the impact of differential rates of CT scans on cancer risk using published attributable risks.
    Results: Among 59,010 children identified, CT rates were higher among injured children treated at ATC and MTC versus PTC. Findings were consistent after stratified analyses and were most striking in children with chest and abdomen/pelvis CT, adolescent age, low injury severity and fall injury mechanism. We estimated that for every 100,000 injured children, imaging practices in ATC and MTC would lead to an additional 17 and 16 lifetime cancers, respectively, when compared to PTC.
    Conclusion: CT use among injured children is higher at ATC and MTC compared to PTC. Children with low injury severity, fall injury mechanism, and adolescent age are most vulnerable to differential imaging practices across centers. Quality improvement initiatives aimed at reducing heterogeneity in CT usage across trauma centers are required to mitigate pediatric Puromycin exposure and cancer risk.
    * Corresponding author at: Division of General Surgery, Department of Surgery, University of Toronto, Sunnybrook Health Sciences, 2075 Bayview Ave, Suite D574, Toronto, OH, M4N 3M5, Canada.
    E-mail addresses: [email protected] (C. Sathya), [email protected] (A.S. Alali), [email protected] (P.W. Wales), [email protected] (J.C. Langer), [email protected] (B.D. Kenney), [email protected] (R.S. Burd), [email protected] (M.L. Nance), [email protected] (A.B. Nathens).
    Background
    Computed tomography (CT) can be an invaluable tool during the evaluation of injured children [1,2]. For this reason, trauma remains one of the commonest indications for CT in children [2,3]. However, children are particularly vulnerable to CT radiation and its associated cancer risk [4,5]. Children are exposed to more radiation during fixed dose CT because of their relatively smaller cross sectional area when compared to adults. Further, they are at
    higher risk due to the increased radiosensitivity of their developing organs and the potential oncogenic effect of radiation is higher in children due to their longer life expectancy [4]. These risks have prompted hospitals to develop strategies limiting the use of CT in children when possible [4]. Pediatric CT protocols, such as the ALARA (as low as reasonably achievable) pediatric CT intelligent dose reduction protocol, have also been developed to minimize radiation exposure [6].
    Despite these strategies, significant variability in CT usage and adherence to pediatric radiation dose reduction protocols has been demonstrated among hospitals caring for injured children in the U. S. [5,7]. Part of this variability may be explained by a lack of specific focus in this area at non-pediatric trauma centers caring for injured children. Pediatric trauma centers (PTC) were developed to provide optimal care to injured children by addressing their unique physiological and psychosocial needs [8–10]. In the U.S., limited access to pediatric trauma centers necessitates that most injured children be treated at non-pediatric centers [11], either adult trauma centers (ATC) or adult trauma centers with added pediatric qualifications (MTC-mixed trauma centers). It is plausible that pediatric and non-pediatric trauma centers have different approaches with respect to the importance of limiting radiation exposure in children. Several studies have shown higher rates of CT usage at adult versus pediatric trauma centers [12–15]. These studies have been limited by small sample sizes, state-specific or regional data, lack of stratified analyses in children with varying injury severity and mechanism, and an inability to compare all trauma center types (ATC, MTC, and PTC) in one analysis [13,14].