A new Journal of Pediatric Surgery study shows how one pediatric trauma center was able to lower the number of CT scans in children with blunt traumatic injuries, subsequently lowering health care costs as well as radiation-related cancer risks without compromising care. [1]
Reducing unnecessary CT scans can be especially impactful for children, according to the National Cancer Institute, since they are typically more sensitive to radiation exposure than adults. With this in mind, the pediatric trauma center involved in the study—located at UR Medicine Golisano Children’s Hospital in Rochester, New York—adjusted its approach to ordering CT imaging for children younger than age 16.
Namely, the trauma center strictly implemented existing CT imaging guidelines across four categories: the head, cervical spine, chest and the abdomen/pelvis.
“Guidelines have always been available for these areas, but the methods in which our department rigorously applied them, tracked the results, and looked to continuously improve are unique,” said Derek Wakeman, MD, an associate professor at the University of Rochester and one of the study’s authors.
A review of CT scans from before the guidelines’ rigorous implementation showed that 51% of all scans taken were not indicated by imaging guidelines. After implementation, only 25% of scans were not indicated, with reductions across all four categories.
Not only were there no clinically significant missed injuries during the post-implementation era, but costs per patient were significantly decreased—dropping charges related to non-indicated scans from $1,490 per patient to $408 per patient.
“Clinicians often feel compelled to do a CT scan and not risk missing something really important,” Wakeman said. “But, there are alternative ways to rule out conditions without a CT scan. If a child is awake and alert, we don’t necessarily need a CT scan to determine concussion risk. If blood work looks normal and the child does not have significant abdominal pain, we can often omit an abdominal CT. For possible cervical spine injuries, x-rays can help pick up significant injuries.”
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