Review, monitor, educate: A quality improvement initiative for sustained chest radiation reduction in pediatric trauma patients.
Adolescent
Child
Child, Preschool
Clinical Decision-Making
/ methods
Female
Humans
Infant
Male
Quality Improvement
Radiation Exposure
/ prevention & control
Retrospective Studies
Thoracic Injuries
/ diagnostic imaging
Tomography, X-Ray Computed
/ standards
Wounds, Nonpenetrating
/ diagnostic imaging
Chest CT
Chest x-ray
Pediatric chest trauma
Quality improvement
Radiation reduction
Journal
American journal of surgery
ISSN: 1879-1883
Titre abrégé: Am J Surg
Pays: United States
ID NLM: 0370473
Informations de publication
Date de publication:
11 2020
11 2020
Historique:
received:
17
02
2020
revised:
14
05
2020
accepted:
25
06
2020
pubmed:
16
9
2020
medline:
5
1
2021
entrez:
15
9
2020
Statut:
ppublish
Résumé
We hypothesize that in pediatric trauma patients, CT scans after normal chest x-rays do not add information that alters clinical decision making. A retrospective review of trauma patients < 15 years with chest imaging evaluated at a pediatric trauma center between 1/2013 and 6/2019 was performed. Imaging was reviewed for significant findings that could affect care. A guideline was established in January 2017 which emphasized x-rays prior to CTs and no CTs after normal x-rays. A prospective review was performed from 1/2017-6/2019. Pre and post guideline groups were compared. From 2013 to 2016, 246 patients met inclusion. 29.5% had a chest CT after a normal x-ray, only 1.8% (1/57) had a significant result. From 2017 to 2019, 188 patients were reviewed post guideline; only 9.4% received a CT after normal x-ray, of which 6.3% (1/16) were significant. Neither changed clinical management. Chest CT following normal chest x-ray does not change clinical management in pediatric trauma patients. Monitoring and education following guideline implementation improves long term outcomes.
Sections du résumé
BACKGROUND
We hypothesize that in pediatric trauma patients, CT scans after normal chest x-rays do not add information that alters clinical decision making.
METHODS
A retrospective review of trauma patients < 15 years with chest imaging evaluated at a pediatric trauma center between 1/2013 and 6/2019 was performed. Imaging was reviewed for significant findings that could affect care. A guideline was established in January 2017 which emphasized x-rays prior to CTs and no CTs after normal x-rays. A prospective review was performed from 1/2017-6/2019. Pre and post guideline groups were compared.
RESULTS
From 2013 to 2016, 246 patients met inclusion. 29.5% had a chest CT after a normal x-ray, only 1.8% (1/57) had a significant result. From 2017 to 2019, 188 patients were reviewed post guideline; only 9.4% received a CT after normal x-ray, of which 6.3% (1/16) were significant. Neither changed clinical management.
CONCLUSIONS
Chest CT following normal chest x-ray does not change clinical management in pediatric trauma patients. Monitoring and education following guideline implementation improves long term outcomes.
Identifiants
pubmed: 32928539
pii: S0002-9610(20)30398-6
doi: 10.1016/j.amjsurg.2020.06.043
pii:
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
1327-1332Informations de copyright
Copyright © 2020. Published by Elsevier Inc.