Avoid the routine use of whole-body CT scanning (pan-scanning) in pediatric trauma patients.
|Rationale and Comments:||While CT scans can be a helpful adjunct to diagnosing traumatic injuries, their usage should be tailored to the mechanism of injury and clinical findings. Radiation from CT scans places children at a low but real risk of developing potentially fatal malignancies later in life. Decision rules have been developed to guide the judicious use of CT scans for evaluating traumatic head, cervical spine, chest, and abdominal/pelvic injuries. Chest CTs, in particular, have limited value in the evaluation of pediatric patients with blunt trauma as few findings require specific treatments that change management. Adherence to published guidelines helps reduce unnecessary scans and reduce costs while minimizing significant missed injuries.|
|References:||• Brenner DJ, Hall EJ. Computed tomography--an increasing source of radiation exposure. N Engl J Med. 2007;357:2277-2284.
• Pearce MS, Salotti JA, et al. Radiation exposure from CT scans in childhood and subsequent risk of leukaemia and brain tumours: a retrospective cohort study. Lancet [Internet]. 2012 Aug 4;380(9840):499-505.
• Kuppermann N, Holmes JF, et al. Pediatric Emergency Care Applied Research Network (PECARN). Identification of children at very low risk of clinically-important brain injuries after head trauma: a prospective cohort study. Lancet [Internet]. 2009 Oct;374(9696):1160-1170.
• Hoffman JR, Mower WR, et al. Validity of a set of clinical criteria to rule out injury to the cervical spine in patients with blunt trauma. National Emergency X-Radiography Utilization Study Group. N Engl J Med. 2000 Jul 13;343(2):94-99.
• Leonard JC. Cervical spine injury. Pediatr Clin North Am. 2013 Oct;60(5):1123-1137. • Stephens CQ, Boulos MC, et al. Limiting thoracic CT: a rule for use during initial pediatric trauma evaluation. J Pediatr Surg. 2017 Dec;52(12):2031-2037.
• Streck CJ, Vogel AM, et al. Pediatric Surgery Research Collaborative. Identifying children at very low risk for blunt intra-abdominal injury in whom CT of the abdomen can be avoided safely. J Am Coll Surg. 2017 Apr;224(4):449-458.