An evidence-based algorithm decreases computed tomography use in hemodynamically stable pediatric blunt abdominal trauma patients.
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In brief
In brief
Implementation of an evidence-based clinical algorithm reduced CT scan use by 27% in hemodynamically stable pediatric blunt abdominal trauma patients without missing injuries or increasing resource utilization. The protocol safely decreased radiation exposure while shortening emergency department length of stay by 53 minutes.
Written by the GCMD Library team from the article.
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.
doi: 10.1016/j.amjsurg.2020.01.006