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Computed tomography rates in pediatric trauma patients among emergency medicine and pediatric emergency medicine physicians

      Highlights

      • What is currently known about this topic?.
        • Pediatric trauma centers do fewer CT scans of pediatric trauma patients than adult trauma centers, but factors contributing to this difference are unclear.
      • What new information is contained in this article?.
        • Pediatric emergency medicine attendings order fewer CT scans than emergency medicine attendings for pediatric trauma patients when evaluated at a single institution with equal pediatric resources.

      Abstract

      Background

      Pediatric trauma patients undergo fewer computed tomography (CT) scans when evaluated at pediatric trauma centers (PTC) versus adult trauma centers (ATC) with no change in clinical outcome. Factors contributing to this difference are unclear. We sought to identify whether the training background of physicians, specifically emergency medicine (EM) versus pediatric emergency medicine (PEM), affected the CT rate of pediatric trauma patients within one institution.

      Methods

      A single-center retrospective study of CT utilization based on attending physicians’ training in trauma patients <18 years between November 2018 and November 2020. Attendings were categorized into two groups: EM residency with no PEM fellowship, or pediatrics/EM residency with PEM fellowship. Primary outcomes measured were the proportion of patients receiving a CT and CT positivity rate.

      Results

      Of 463 study patients, CTs were obtained in 145/228 (64%) patients by EM, and 130/235 (55%) by PEM (p=.07). CT positivity rate was 21% and 19% in EM and PEM, respectively (p=.46). The mean number of CTs per patient in EM was 2.8 compared to 2.1 in PEM (p<.01), and for patients with an injury severity score (ISS) >15, mean number of CTs per patient increased to 4.9 in EM versus 2.4 in PEM (p=.01).

      Conclusions

      The mean number of CTs ordered per patient was statistically higher for EM attendings. The differences between CT rates highlight future opportunities for ongoing development of pediatric trauma imaging guidelines and radiation exposure reduction.

      Levels of evidence

      Retrospective Study, Level III

      Keywords

      Abbreviations:

      ATC (Adult Trauma Center), CT (Computed Tomography), ED (Emergency Department), EM (Emergency Medicine), ISS (Injury Severity Score), PECARN (Pediatric Emergency Care Applied Research Network), PEM (Pediatric Emergency Medicine), PTC (Pediatric Trauma Center)
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