Computed tomography before transfer to a level I pediatric trauma center risks duplication with associated increased radiation exposure



      Community hospitals commonly obtain computed tomographic (CT) imaging of pediatric trauma patients before triaging to a level I pediatric trauma center (PTC). This practice potentially increases radiation exposure when imaging must be duplicated after transfer.


      A retrospective review of our level 1 PTC registry from January 1, 2004, to December 31, 2006, was conducted. Level I and II trauma patients were grouped based on whether they had undergone outside CT examination (head and/or abdomen) at a referring hospital (group 1) or received initial CT examination at our institution (group 2). Subgroups were analyzed based on whether duplicate CT examination was required at our PTC (Fischer's Exact test).


      A duplicate CT scan (within 4 hours of transfer) was required in 91% (30/33) of group 1 transfer patients, whereas no group 2 patient required a duplicate scan (0/55; P < .0001). There was no significant difference within the groups for weight, age, or intensive care unit length of stay.


      A significant number of pediatric trauma patients who receive CT scans at referring hospitals before transfer to our level I PTC require duplicate scans of the same anatomical field(s) after transfer, exposing them to increase potential clinical risk and cost.

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        • Paterson A.
        • Donald P.F.
        • Donnelly L.F.
        Helical CT of the body—are settings adjusted for pediatric patients.
        AJR Am J Roentgenol. 2001; 176: 297-301
        • Brenner D.J.
        • Elliston C.D.
        • Hall E.J.
        • et al.
        Estimated risks of radiation-induced fatal cancer from pediatric CT.
        AJR Am J Roentgenol. 2001; 176: 289-296
        • Brenner D.J.
        • Hall E.J.
        Computed tomography—an increasing source of radiation exposure.
        N Engl J Med. 2007; 357: 2277-2284
        • Linton O.W.
        • Mettler Jr, F.A.
        National conference on dose reduction in CT, with an emphasis on pediatric patients.
        AJR Am J Roentgenol. 2003; 181: 321-329
        • Fang J.F.
        • Wong Y.C.
        • Lin B.C.
        • et al.
        Usefulness of multidetector computed tomography for the initial assessment of blunt abdominal trauma patients.
        World J Surg. 2006; 30: 176-182
        • Hendershot K.M.
        • Fakhry S.M.
        • Hakiman H.
        • et al.
        Duration and safety if computed tomography in severely injured blunt trauma patients.
        in: Poster presentation at the Sixty Fifth Annual Meeting of the American Association for the Surgery of Trauma, New Orleans, LA, September 282006
        • Winchell R.J.
        • Hoyt D.B.
        • Simons R.K.
        Use of computed tomography of the head in the hypotensive blunt-trauma patient.
        Ann Emerg Med. 1995; 25: 737-742
        • Leach P.
        • Childs C.
        • Evans J.
        • et al.
        Transfer times for patients with extradural and subdural haematomas to neurosurgery in Greater Manchester.
        Br J Neurosurg. 2007; 21: 11-15
        • Sampalis J.S.
        • Denis R.
        • Fréchette P.
        • et al.
        Direct transport to tertiary trauma centers versus transfer from lower level facilities impact on mortality and morbidity among patients with major trauma.
        J Trauma. 1997; 43 ([discussion 295-6]): 288-295
        • Hessmann M.H.
        • Hofmann A.
        • Kreitner K.F.
        • et al.
        The benefit of multislice CT in the emergency room management of polytraumatized patients.
        Acta Chir Belg. 2006; 106: 500-507
        • Huda W.
        • Atherton J.V.
        • Ware D.E.
        • et al.
        An approach for the estimation of effective radiation dose at CT in pediatric patients.
        Radiology. 1997; 203: 417-422
        • Committee on the Biological Effects of Ionizing Radiation (BEIR V), National Research Council
        Health effects of exposure to low levels of ionizing radiation: BIER V. National Academy Press, Washington, DC1990: 1-436
      1. Slovis TL, editor. ALARA conference proceedings. The ALARA concept in pediatric CT: intelligent dose reduction. Pediatr Radiol. 2002;32:217-317.

        • Morgan H.T.
        Dose reduction for CT pediatric imaging.
        Pediatr Radiol. 2002; 32: 724-728
        • Donnelly L.F.
        • Emery K.H.
        • Brody A.S.
        • et al.
        Minimizing radiation dose for pediatric body applications of single-detector helical CT: strategies at a large children's hospital.
        AJR Am J Roentgenol. 2001; 176: 303-306
        • Patzer L.
        Nephrotoxicity as a cause of acute kidney injury in children.
        Pediatr Nephrol. 2008; (Epub online)
        • Sivit C.J.
        • Ingram J.D.
        • Taylor G.A.
        • et al.
        Posttraumatic adrenal hemorrhage in children: CT findings in 34 patients.
        Radiology. 1992; 182: 723-726
        • Nisenbaum H.L.
        • Birnbaum B.A.
        • Myers M.M.
        • et al.
        The costs of CT procedures in an academic radiology department determined by an activity-based costing (ABC) method.
        J Comput Assist Tomogr. 2000; 24: 813-823