Bahman Sayyar Roudsari MD, PhD, Abstract Co-Author: Nothing to Disclose

Kevin Psoter, Presenter: Nothing to Disclose

Christopher Mack MSc, Abstract Co-Author: Nothing to Disclose

Jeffrey Gil Jarvik MD, MPH, Abstract Co-Author: Stockholder, PhysioSonics, Inc Research Advisory Board, General Electric Company Consultant, HealthHelp

Falls are a leading cause of pediatric-related morbidity and mortality in the US. The purpose of this study was to evaluate the 14 year trend in computed tomography (CT) utilization in pediatric fall victims at a level I trauma center.

We linked Harborview Medical Center (HMC) trauma registry to HMC billing department data from 1996 to 2009. Trauma registry included detailed information regarding patient and injury characteristics. Billing data included detailed information on type and frequency of CTs performed. Age was classified into the following categories: 0-9, 10-14 and 15-18 years. Negative binomial regression was used to evaluate the association between CT utilization and age, adjusting for gender, year of admission, referral status, ISS, length of hospitalization, ICU admission, and final disposition, considering the15-18 years group as the baseline for comparison.

A total of 2,347 trauma patients, 0-18 years, were admitted to HMC for fall related injuries from 1996-2009. The mean age of patients was 7 years, 67% were males and 44% were admitted to the ICU. The most commonly performed CTs were head (1.2 CTs/ person), cervical spine (0.4 CTs/person), pelvis (0.4 CTs / person) and abdomen (0.3 CTs/person). The crude number of head CTs increased from 1.5 CTs/ patient in 1996 to 1.8 CTs/patient in 1998 and then gradually declined to 1.0 CT/ patient in 2009. Abdomen CT use increased from 0.2 CTs/patient in 1996 to 0.5 CTs/patient in 2000 and has slowly declined to 0.3 CTs/patient in 2009. From 1996-2007, increased use of cervical spine (0.1 to 0.5 CTs/ patient) and pelvic (0.2 to 0.7 CTs /patient) CTs was observed with subsequent declines to 0.3 CTs/ patient and 0.5 CTs/patientin, respectively, in 2009. The use of cervical spine, abdomen, and pelvic CTs increased significantly after adjusting for potential confounders. Head CT utilization rate remained relatively unchanged during the study period, with a slight decrease in 2009. 

Over the study period, CT utilization in the pediatric population increased steadily; however, in recent years significant declines were observed. This may be partially attributed to imaging guidelines and institutional protocols to decrease unnecessary CT use.

Well defined imaging protocols have the potential to minimize unnecessary utilization of CT in trauma patients which is particularly important for pediatric patients.

Sayyar Roudsari, B, Psoter, K, Mack, C, Jarvik, J, The Role of CT in the Management of Pediatric Fall-related Injuries in a Level I Trauma Center: A 14 Year Trend Analysis.  Radiological Society of North America 2012 Scientific Assembly and Annual Meeting, November 25 - November 30, 2012 ,Chicago IL. http://archive.rsna.org/2012/12028211.html