The Radiation Footprint on the Pediatric Trauma Patient
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BACKGROUND: Overuse of radiation in patients has recently become an important topic of discussion within the medical community. Pediatric patients are most at risk. A recent study has proven the incidence of 1 brain tumor for every 10,000 head computed tomography (CT) scans among patients under the age of 10 in the ten years following a single scan1. Although there have been attempts to limit radiation dosage, there is no published data on the quantity of imaging done on the pediatric trauma patient. The high index of suspicion in trauma has created a paradigm of comprehensive imaging independent of symptoms. Our hypothesis was to identify the current amount of radiation used in a pediatric trauma patient for one visit and correlate the levels of imaging with trauma activation status in order to identify the subset of pediatric trauma patients most at risk for over-radiation. METHODS: This IRB-approved retrospective review of pediatric trauma patients at an ACS verified Level 1 independent children's hospital reviewed three levels of trauma activation (Stats, Alerts, Consults) from June 2010 to January 2011. Charts were analyzed for demographics, mechanism of injury, injury severity score (ISS), imaging modalities, and radiation dosages. Our study included the total number of Stats with representative cohorts from Alerts and Consults. 215 patients (N=1050) met inclusion criteria with complete dosimetry data available. RESULTS: The demographics include: gender (143M, 72F); age range <1-16 years (median 5.5), and activation status with average ISS score (Consults, 7.7 ± 9; Alerts, 8.8 ± 7; and Stats, 17 ± 14, respectively). Non-accidental trauma (NAT) and Stat activations exceeded all others in radiation exposure. Per Stat the number of CTs ranged from 0-10 with 2-3 CTs in 35% and 4-10 CTs in 40% for one admission. The studies most often repeated were head CTs (45%), face/sinus CTs (13.8%) and neck CTs (10%). The majority (66%) of outside CTs delivered more radiation, of which 50.0% of the doses were at least double the dosage delivered at the children's hospital. CONCLUSION: This study is the first to correlate the amount of radiation exposure with trauma activation status. Most of the repetitive imaging was utilized in Stat activations and NATs and used 2-3 times as many CT scans. The identified factors associated with the most radiation include suspected NATs, Stat activations, and outside imaging. To minimize the radiation footprint, we may need to change the current practice of imaging to identify all possible injuries regardless of symptoms.