A number of years ago when a healthcare quality consortium was looking for a project, we proposed they study the patterns of CT scan usage in children across regional hospitals. We strongly suspected that efforts to minimize the use of ionizing radiation in children were probably less developed in non-pediatric facilities. The consortium chose another project but a recent study has demonstrated that, at least for cranial CT scans in children with trauma, the dose of radiation received at non-pediatric hospitals is roughly twice that at pediatric trauma centers.
Nabaweesi and colleagues (Nabaweesi 2017) looked at injured children younger than 18 years who received a CT scan at a referring hospital and were subsequently transferred to a pediatric trauma center. The median effective radiation dose received at non-pediatric hospitals was twice that received at the pediatric trauma center (3.8 versus 1.6 mSv). Their results were confirmed even after controlling for mode of transportation, emergency department disposition, level of injury severity, non-pediatric hospital trauma center level, hospital type, size, region, and radiology services location. The authors strongly suggest adoption of pediatric CT protocols.
Nabaweesi and colleagues note that use of cranial CT scans in children has been increasing, in part due to increased awareness of sports-related concussions.
Much of the focus on the risks of ionizing radiation exposure in children has focused on avoiding unnecessary imaging, CT scanning in particular because of its relatively high levels of radiation. We’ve discussed in prior columns programs like Imaging Gently® and also use of clinical decision rules to help guide decisions about imaging (see for example our September 2017 What's New in the Patient Safety World column “”).
The New Jersey Hospital Association has recently led a collaborative to reduce unnecessary radiation exposure from CT scanning in children (NJHA 2017a). They sought to standardize protocols for head CT scans in children, for both the decision-making process (clinical observation criteria and an algorithm) and for the proper radiation dosage. NJHA created a laminated pocket card of the algorithm and shared it with emergency room physicians and nurses across the state and partnered in a number of education programs.
Twelve months later, new data shows that avoidable pediatric head CT scans decreased by 25 percent in New Jersey hospitals.
Now they have developed a #SCANSMART Toolkit (NJHA 2017b) and have shifted focus to the community, educating parents, coaches, trainers and others with posters and pamphlets highlighting both the benefits and risks of CT imaging.
Some of our previous columns on the issue of radiation risk:
Nabaweesi R, Ramakrishnaiah RH, Aitken ME, et al. Injured Children Receive Twice the Radiation Dose at Nonpediatric Trauma Centers Compared With Pediatric Trauma Centers. J Am Coll Radiol 2017; Published online: August 25, 2017
NJHA (New Jersey Hospital Association). ScanSmart: New Patient Safety Initiative Calls for Cool Heads When Using CT Scans on Kids. PR Newswire 2017; Sep. 14, 2017
NJHA (New Jersey Hospital Association) Institute for Quality and Patient Safety. #SCANSMART – Safe CT Imaging.