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Injury. 2019 Jan;50(1):142-148. doi: 10.1016/j.injury.2018.09.036. Epub 2018 Sep 19.

Computed tomography rates and estimated radiation-associated cancer risk among injured children treated at different trauma center types.

Author information

1
Division of General Surgery, Department of Surgery, University of Toronto, Toronto, Canada; Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Canada. Electronic address: chethan.sathya@gmail.com.
2
Department of Neurological Surgery University of Washington Seattle, WA. Electronic address: azizalali81@gmail.com.
3
Division of General Surgery, Department of Surgery, University of Toronto, Toronto, Canada; Division of General and Thoracic Surgery, Hospital for Sick Children, Toronto, Canada. Electronic address: paul.wales@sickkids.ca.
4
Division of General Surgery, Department of Surgery, University of Toronto, Toronto, Canada; Division of General and Thoracic Surgery, Hospital for Sick Children, Toronto, Canada. Electronic address: jacob.langer@sickkids.ca.
5
Department of Pediatric Surgery, Nationwide Children's Hospital, Columbus, OH, USA. Electronic address: brian.kenney@nationwidechildrens.org.
6
Division of General and Thoracic Surgery, Children's National Health System, Washington DC, USA. Electronic address: RBurd@childrensnational.org.
7
Division of General and Thoracic Surgery, Children's Hospital of Philadelphia, Philadelphia, USA. Electronic address: nance@email.chop.edu.
8
Division of General Surgery, Department of Surgery, University of Toronto, Toronto, Canada; Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Canada; Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Canada; Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Canada. Electronic address: avery.nathens@sunnybrook.ca.

Abstract

BACKGROUND:

Trauma is a common indication for computed tomography (CT) in children. However, children are particularly vulnerable to CT radiation and its associated cancer risk. Identifying differences in CT usage across trauma centers and among specific populations of injured children is needed to identify where quality improvement initiatives could be implemented in order to reduce excess radiation exposure to children. We evaluated computed tomography (CT) rates among injured children treated at pediatric (PTC), mixed (MTC), or adult trauma centers (ATC) and estimated the resulting differential in potential cancer risk.

METHODS:

We identified children age ≤18 years with blunt injury AIS ≥2 treated from 2010 to 2013 at 130 U.S trauma centers participating in the Trauma Quality Improvement Program. CT rates were compared across center types using Chi-square analysis. Stratified analyses in children with varying injury severity, mechanism, and age were performed. We estimated the impact of differential rates of CT scans on cancer risk using published attributable risks.

RESULTS:

Among 59,010 children identified, CT rates were higher among injured children treated at ATC and MTC versus PTC. Findings were consistent after stratified analyses and were most striking in children with chest and abdomen/pelvis CT, adolescent age, low injury severity and fall injury mechanism. We estimated that for every 100,000 injured children, imaging practices in ATC and MTC would lead to an additional 17 and 16 lifetime cancers, respectively, when compared to PTC.

CONCLUSION:

CT use among injured children is higher at ATC and MTC compared to PTC. Children with low injury severity, fall injury mechanism, and adolescent age are most vulnerable to differential imaging practices across centers. Quality improvement initiatives aimed at reducing heterogeneity in CT usage across trauma centers are required to mitigate pediatric radiation exposure and cancer risk.

KEYWORDS:

Cancer; Computed tomography; Pediatric trauma; Quality indicator; Radiation; Trauma center

PMID:
30270009
DOI:
10.1016/j.injury.2018.09.036
[Indexed for MEDLINE]

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