Osayi A Odia1, Brian Yorkgitis2, Lori Gurien3, Phyllis Hendry4, Marie Crandall5, David Skarupa6, Jennifer N Fishe7. 1. Department of Emergency Medicine, Division of Pediatric Emergency Medicine, University of Florida College of Medicine - Jacksonville, 655 W 8th St., Jacksonville, FL, 32209, USA. Electronic address: Osayi.Odia@jax.ufl.edu. 2. Department of Surgery, Division of Acute Care Surgery, University of Florida College of Medicine - Jacksonville, 655 W. 8th St., Jacksonville, FL, 32209, USA. Electronic address: Brian.Yorkgitis2@jax.ufl.edu. 3. Department of Surgery, Division of Acute Care Surgery, University of Florida College of Medicine - Jacksonville, 655 W. 8th St., Jacksonville, FL, 32209, USA. Electronic address: Lori.Gurien@jax.ufl.edu. 4. Department of Emergency Medicine, Division of Pediatric Emergency Medicine, University of Florida College of Medicine - Jacksonville, 655 W 8th St., Jacksonville, FL, 32209, USA. Electronic address: Phyllis.Hendry@jax.ufl.edu. 5. Department of Surgery, Division of Acute Care Surgery, University of Florida College of Medicine - Jacksonville, 655 W. 8th St., Jacksonville, FL, 32209, USA. Electronic address: Marie.Crandall@jax.ufl.edu. 6. Department of Surgery, Division of Acute Care Surgery, University of Florida College of Medicine - Jacksonville, 655 W. 8th St., Jacksonville, FL, 32209, USA. Electronic address: David.Skarupa@jax.ufl.edu. 7. Department of Emergency Medicine, Division of Pediatric Emergency Medicine, University of Florida College of Medicine - Jacksonville, 655 W 8th St., Jacksonville, FL, 32209, USA. Electronic address: Jennifer.Fishe@jax.ufl.edu.
Abstract
BACKGROUND: There are concerns about overuse of abdominopelvic-computed tomography (CTAP) in pediatric blunt abdominal trauma (BAT) given malignancy risks. This study evaluates how an evidence-based algorithm affected CTAP and hospital resource use for hemodynamically stable children with BAT. MATERIALS AND METHODS: This is a retrospective cohort study of hemodynamically stable pediatric BAT patients one year before and after algorithm implementation. We included children less than or equal to 14 years of age treated in a Level I pediatric trauma center. We compared CTAP rates before and after algorithm implementation. RESULTS: There were 65 in the pre- and 50 in the post-algorithm implementation group, and CTAPs decreased by 27% (p = 0.02). The unadjusted and adjusted odds ratio of receiving a CTAP after algorithm implementation were 0.3 (95% CI 0.1-0.6) and 0.2 (95% CI 0.1-0.7), respectively. There were no significant missed injuries in the post cohort. ED length of stay (LOS) decreased by 53 min (p = 0.03). CONCLUSIONS: An evidence-based algorithm safely decreased CTAPs for pediatric BAT with no increase in hospital resource utilization.
BACKGROUND: There are concerns about overuse of abdominopelvic-computed tomography (CTAP) in pediatric blunt abdominal trauma (BAT) given malignancy risks. This study evaluates how an evidence-based algorithm affected CTAP and hospital resource use for hemodynamically stable children with BAT. MATERIALS AND METHODS: This is a retrospective cohort study of hemodynamically stable pediatric BATpatients one year before and after algorithm implementation. We included children less than or equal to 14 years of age treated in a Level I pediatric trauma center. We compared CTAP rates before and after algorithm implementation. RESULTS: There were 65 in the pre- and 50 in the post-algorithm implementation group, and CTAPs decreased by 27% (p = 0.02). The unadjusted and adjusted odds ratio of receiving a CTAP after algorithm implementation were 0.3 (95% CI 0.1-0.6) and 0.2 (95% CI 0.1-0.7), respectively. There were no significant missed injuries in the post cohort. ED length of stay (LOS) decreased by 53 min (p = 0.03). CONCLUSIONS: An evidence-based algorithm safely decreased CTAPs for pediatric BAT with no increase in hospital resource utilization.