Elizabeth Boudiab1, Samer Kawak1, Alan Tom1, Diane Studzinski1, Nathan Novotny2,3, Pavan Brahmamdam2,3, Begum Akay4,5,6. 1. Department of Pediatric Surgery, Beaumont Health, Royal Oak, MI, USA. 2. Section of Pediatric Surgery, Beaumont Children's, Royal Oak, MI, USA. 3. Oakland University William Beaumont School of Medicine, Rochester, MI, USA. 4. Section of Pediatric Surgery, Beaumont Children's, Royal Oak, MI, USA. begum.akay@beaumont.org. 5. Oakland University William Beaumont School of Medicine, Rochester, MI, USA. begum.akay@beaumont.org. 6. Department of Pediatric Surgery, Beaumont Children's, Oakland University William Beaumont School of Medicine, 3535 West 13 Mile Road, Suite 307, Royal Oak, MI, 48073, USA. begum.akay@beaumont.org.
Abstract
PURPOSE: Computed tomography (CT) is currently the standard for evaluation of intra-abdominal injury (IAI) after BAT. Pediatric patients receiving CT scans based on adult clinical protocols are potentially exposed to unnecessary radiation. The purpose of this study is to determine the rate of CT scans before and after implementation of a pediatric BAT decision tool. METHODS: We adapted and implemented an evidence-based decision tool for pediatric BAT based on five clinical variables. We reviewed patient charts 18 months pre- and post-implementation. Demographics and outcomes were compared using Chi-square and Fisher's exact test, accordingly. RESULTS: The pre and post-implementation groups were uniform when comparing age, sex, mechanism, and Injury Severity Score. The decision tool was utilized in 85% of patients post-implementation. Fewer CT scans were obtained in the post-implementation group (28 vs. 21%, p = 0.215) with no missed injuries or late diagnoses. CONCLUSION: Implementation of a pediatric BAT decision tool decreased CT usage and radiation exposure without an obvious compromise to patient care. This experience supports the utilization of these tools for the assessment of IAI after BAT and have resulted in more selective use of CT during pediatric BAT in our program.
PURPOSE: Computed tomography (CT) is currently the standard for evaluation of intra-abdominal injury (IAI) after BAT. Pediatric patients receiving CT scans based on adult clinical protocols are potentially exposed to unnecessary radiation. The purpose of this study is to determine the rate of CT scans before and after implementation of a pediatric BAT decision tool. METHODS: We adapted and implemented an evidence-based decision tool for pediatric BAT based on five clinical variables. We reviewed patient charts 18 months pre- and post-implementation. Demographics and outcomes were compared using Chi-square and Fisher's exact test, accordingly. RESULTS: The pre and post-implementation groups were uniform when comparing age, sex, mechanism, and Injury Severity Score. The decision tool was utilized in 85% of patients post-implementation. Fewer CT scans were obtained in the post-implementation group (28 vs. 21%, p = 0.215) with no missed injuries or late diagnoses. CONCLUSION: Implementation of a pediatric BAT decision tool decreased CT usage and radiation exposure without an obvious compromise to patient care. This experience supports the utilization of these tools for the assessment of IAI after BAT and have resulted in more selective use of CT during pediatric BAT in our program.
Authors: Chase A Arbra; Adam M Vogel; Leah Plumblee; Jingwen Zhang; Patrick D Mauldin; Melvin S Dassinger; Robert T Russell; Martin L Blakely; Christian J Streck Journal: J Trauma Acute Care Surg Date: 2018-07 Impact factor: 3.313
Authors: Christian J Streck; Adam M Vogel; Jingwen Zhang; Eunice Y Huang; Matthew T Santore; Kuojen Tsao; Richard A Falcone; Melvin S Dassinger; Robert T Russell; Martin L Blakely Journal: J Am Coll Surg Date: 2017-01-24 Impact factor: 6.113
Authors: David B Larson; Lara W Johnson; Beverly M Schnell; Shelia R Salisbury; Howard P Forman Journal: Radiology Date: 2010-11-29 Impact factor: 11.105
Authors: David B Larson; Lara W Johnson; Beverly M Schnell; Marilyn J Goske; Shelia R Salisbury; Howard P Forman Journal: Radiology Date: 2011-04-05 Impact factor: 11.105
Authors: James F Holmes; Kathleen Lillis; David Monroe; Dominic Borgialli; Benjamin T Kerrey; Prashant Mahajan; Kathleen Adelgais; Angela M Ellison; Kenneth Yen; Shireen Atabaki; Jay Menaker; Bema Bonsu; Kimberly S Quayle; Madelyn Garcia; Alexander Rogers; Stephen Blumberg; Lois Lee; Michael Tunik; Joshua Kooistra; Maria Kwok; Lawrence J Cook; J Michael Dean; Peter E Sokolove; David H Wisner; Peter Ehrlich; Arthur Cooper; Peter S Dayan; Sandra Wootton-Gorges; Nathan Kuppermann Journal: Ann Emerg Med Date: 2013-02-01 Impact factor: 5.721
Authors: Willem-Jan J de Jong; Leon Stoepker; David R Nellensteijn; Henk Groen; Mostafa El Moumni; Jan B Hulscher Journal: J Trauma Acute Care Surg Date: 2014-05 Impact factor: 3.313
Authors: Areti Tillou; Malkeet Gupta; Larry J Baraff; David L Schriger; Jerome R Hoffman; Jonathan R Hiatt; Henry M Cryer Journal: J Trauma Date: 2009-10