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Appelhaus S, Schönberg SO, Weis M. CT in pediatric trauma patients. ROFO-FORTSCHR RONTG 2024. [PMID: 39074798 DOI: 10.1055/a-2341-7559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/31/2024]
Abstract
The decision as to whether to perform a computed tomography (CT) examination in severe pediatric trauma poses a challenge. The therapeutic benefit of computed tomography in injured children is lower compared to adults, while the potential negative effects of ionizing radiation may be higher. Thus, the threshold for CT should be higher. Centers that less frequently treat pediatric cases tend to conduct more whole-body CT examinations than dedicated pediatric trauma centers, indicating a clinical overestimation of injury severity with subsequently unnecessary imaging due to inexperience. On the other hand, a CT scan that is not performed but is actually necessary can also have negative consequences if an injury is detected with a delay. An injured child presents a challenging situation for all involved healthcare providers, and thus requires a structured approach to decision-making.Selective literature review of the benefits and risks of CT in injured children, as well as indications for whole-body and region-specific CT imaging.This article provides an overview of current guidelines, recent insight into radiation protection and the benefits of CT in injured children, and evidence-based decision criteria for choosing the appropriate modality based on the mechanism of injury and the affected body region. · Whole-body CT has less of an influence on treatment decisions and mortality in severely injured children than in adults.. · For radiation protection reasons, the indication should be determined more conservatively in children than in adult trauma patients.. · The indication for CT should ideally be determined separately for each region of the body.. · Ultrasound and MRI are a good alternative for the primary diagnostic workup in many situations.. · Appelhaus S, Schönberg SO, Weis M. CT in pediatric trauma patients. Fortschr Röntgenstr 2024; DOI 10.1055/a-2341-7559.
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Affiliation(s)
- Stefan Appelhaus
- Department of Radiology and Nuclear Medicine, University Medical Centre Mannheim, Mannheim, Germany
| | - Stefan O Schönberg
- Department of Radiology and Nuclear Medicine, University Medical Centre Mannheim, Mannheim, Germany
| | - Meike Weis
- Department of Radiology and Nuclear Medicine, University Medical Centre Mannheim, Mannheim, Germany
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Ciorba MC, Maegele M. Polytrauma in Children. DEUTSCHES ARZTEBLATT INTERNATIONAL 2024; 121:291-297. [PMID: 38471125 DOI: 10.3238/arztebl.m2024.0036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Revised: 02/12/2024] [Accepted: 02/12/2024] [Indexed: 03/14/2024]
Abstract
BACKGROUND Inadequate clinical experience still causes uncertainty in the acute diagnostic evaluation and treatment of polytrauma in children (with or without coagulopathy). This review deals with the main aspects of the acute care of severely injured children in the light of current guidelines and other relevant literature, in particular airway control, volume and coagulation management, acute diagnostic imaging, and blood coagulation studies in the shock room. METHODS This review is based on literature retrieved by a selective search in PubMed, Medline (OVIDSP), the Cochrane Central Register of Controlled Trials, and Epistemonikos covering the period January 2001 to August 2023. Review articles and the updated S2k clinical practice guideline on polytrauma management in childhood were considered. RESULTS Most accidents in childhood occur at home and in the child's free time, with varying mechanisms and patterns of injury depending on age. The outcome of treatment depends largely on the presence or absence or traumatic brain injury, which affects 66% of children with polytrauma and is thus the most common type of injury in this group, and of hemorrhagic shock with or without coagulopathy. Acute care follows the ABCDE algorithms with attention to special features in children, including age-specific reference values. According to a registry study, coagulopathy and hypovolemic shock are associated with 22% and 17% mortality, respec - tively. Treatment in a pediatric trauma reference center of the trauma network is recommended. Computed tomography (CT) should be carried out in children in accordance with defined criteria (PECARN), as a team decision and with the use of age-specific low-dose CT protocols. In children as in adults, viscoelasticity-based point-of-care tests enable the prompt diagnosis of relevant coagulopathies and their treatment in consideration of age-specific target values. The administration of tranexamic acid remains controversial. CONCLUSION 4% of polytrauma patients are children. Because children differ from adults both anatomically and physiologically, the diagnostic evaluation and management of polytrauma in children presents a special challenge. The evidence base for pediatric polytrauma management is still inadequate; current recommendations are based on consensus, in consideration of the special features of children compared to adults.
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Affiliation(s)
- Monica Christine Ciorba
- Department of Orthopedics, Trauma Surgery and Sports Traumatology, Cologne-Merheim Medical Center, University of Witten/Herdecke, Cologne, Germany; Institute for Research in Operative Medicine (IFOM), University of Witten/Herdecke, Cologne-Merheim Campus, Cologne, Germany
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Hashimoto H, Takemoto O, Chiba Y. Growth patterns and ratios of posterior cranial fossa structures in the Japanese pediatric population: a study utilizing CT scans. Neuroradiology 2023; 65:1835-1844. [PMID: 37798333 DOI: 10.1007/s00234-023-03229-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Accepted: 09/26/2023] [Indexed: 10/07/2023]
Abstract
PURPOSE The changes in the proportion of posterior cranial fossa structures during pediatric development remain unclear. This retrospective study aimed to investigate the growth patterns and ratios of these structures using CT scans. METHODS Head CT scans of pediatric patients with minor head trauma from Osaka Women's and Children's Hospital between March 2006 and May 2023 were analyzed. The study segmented the intracranial volume (ICV), posterior cranial fossa volume (PCFV), cerebellum volume (CBMV), and brainstem volume (BSV). Correlation coefficients were calculated among the parameters. Patients aged 0 to 10 years were divided into 15 age-related clusters, and mean and standard deviation values were measured. Growth curves were created by plotting mean values sequentially. Ratios such as PCFV/ICV and (CBMV + BSV)/PCFV were examined. Statistical analyses, including unpaired t tests and logarithmic curve fitting, were performed. RESULTS A total of 234 CT scans (97 from females, 115 from infants under 1 year of age) were analyzed. Positive correlations were observed among the parameters, with the strongest between PCFV and CBMV. The growth curves for ICV, PCFV, CBMV, and BSV exhibited a two-phase process, with rapid growth until approximately 4 years of age, followed by stabilization. The ratios PCFV/ICV and (CBMV + BSV)/PCFV showed increasing trends from birth onwards, stabilizing by 4 and 1 years of age, respectively. CONCLUSION This study provides insights into the growth patterns and ratios of posterior cranial fossa structures in the pediatric population. The findings demonstrate a two-phase growth process and increasing trends in the examined ratios.
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Affiliation(s)
- Hiroaki Hashimoto
- Department of Neurosurgery, Osaka Women's and Children's Hospital, Osaka, Izumi, 594-1101, Japan.
- Department of Neurological Diagnosis and Restoration, Graduate School of Medicine, Osaka University, Osaka, Suita, 565-0871, Japan.
| | - Osamu Takemoto
- Department of Neurosurgery, Osaka Women's and Children's Hospital, Osaka, Izumi, 594-1101, Japan
| | - Yasuyoshi Chiba
- Department of Neurosurgery, Osaka Women's and Children's Hospital, Osaka, Izumi, 594-1101, Japan
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Schunn MC, Schäfer J, Neunhoeffer F, Lieber J, Fuchs J. [Blunt abdominal trauma in children and adolescents: treatment concepts in the acute phase]. CHIRURGIE (HEIDELBERG, GERMANY) 2023; 94:651-663. [PMID: 37338573 DOI: 10.1007/s00104-022-01798-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/14/2022] [Indexed: 06/21/2023]
Abstract
Fatal accidents due to blunt force trauma are the leading cause of death in children and adolescents [1]. Abdominal trauma is the third most common cause of death after traumatic brain injury and thoracic injuries [2]. Abdominal injury is seen in approximately 2-5% of children involved in accidents [3]. Blunt abdominal injuries are common sequelae of traffic accidents (for example as seat belt injury), falls, and sports accidents. Penetrating abdominal injuries are rare in central Europe. Spleen, liver, and kidney lacerations are the most common injuries after blunt abdominal trauma [4]. In most situations, nonoperative management (NOM) has become the gold standard with the surgeon leading the multidisciplinary treatment [5].
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Affiliation(s)
- M C Schunn
- Klinik für Kinder- und Jugendmedizin, Abteilung für Kinderchirurgie und Kinderurologie, Universitätsklinikum Tübingen, Hoppe-Seyler-Str. 3, 72076, Tübingen, Deutschland.
| | - J Schäfer
- Diagnostische und Interventionelle Radiologie, Abteilung für Kinderradiologie, Universitätsklinikum Tübingen, Hoppe-Seyler-Str. 3, 72076, Tübingen, Deutschland
| | - F Neunhoeffer
- Klinik für Kinderheilkunde, Abteilung für Kinderkardiologie, Intensivmedizin und Pulmonologie, Universitätsklinikum Tübingen, Hoppe-Seyler-Str. 3, 72076, Tübingen, Deutschland
| | - J Lieber
- Klinik für Kinder- und Jugendmedizin, Abteilung für Kinderchirurgie und Kinderurologie, Universitätsklinikum Tübingen, Hoppe-Seyler-Str. 3, 72076, Tübingen, Deutschland
| | - J Fuchs
- Klinik für Kinder- und Jugendmedizin, Abteilung für Kinderchirurgie und Kinderurologie, Universitätsklinikum Tübingen, Hoppe-Seyler-Str. 3, 72076, Tübingen, Deutschland
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Ishii W, Hitosugi M, Kandori K, Miyaguni M, Iizuka R. Increased CT Use and No Change in Injury Severity among Child Motor Vehicle Victims: A National Trauma Database Study in Japan. Healthcare (Basel) 2023; 11:healthcare11091240. [PMID: 37174781 PMCID: PMC10178139 DOI: 10.3390/healthcare11091240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Revised: 04/12/2023] [Accepted: 04/25/2023] [Indexed: 05/15/2023] Open
Abstract
The number of fatalities associated with traffic accidents has been declining owing to improvements in vehicle safety performance and changes in the law. However, injuries in children can lead to social and economic losses. We examined 10-year changes in the characteristics of traffic trauma among pediatric motor vehicle passengers by analyzing data from the Japan Trauma Data Bank (JTDB). Among the 36,715 injured motor vehicle passengers under the age of 15 years who were registered in the JTDB from 2004 to 2019, we compared the groups injured during 2004-2007 (n = 94) and 2017-2019 (n = 203). Physiologically, the 2004-2007 group had a lower body temperature and Glasgow Coma Scale score as well as a higher mortality. Anatomical severity was higher in the 2004-2007 group for the head, face, and neck, according to the Abbreviated Injury Scale. In terms of treatment, only craniotomy as a primary surgery was significantly lower in the 2017-2019 group. The 2017-2019 group had significantly higher rates of receiving whole-body computed tomography (CT). Because the rate of performing CT has increased, with no changes in the injury severities of the trunk and extremities, limiting the number of CT examinations is suggested for pediatric motor vehicle passengers involved in road traffic collisions. The severity of trunk and extremity injuries has not improved in more than 10 years; further preventive measures for these injuries should be considered.
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Affiliation(s)
- Wataru Ishii
- Emergency of Medicine, Critical Care Center, Kyoto Daini Red Cross Hospital, Haruobi, Kamazamarutamachi, Kamigyo, Kyoto 602-8026, Japan
| | - Masahito Hitosugi
- Department of Legal Medicine, Shiga University of Medical Science, Tsukinowa, Seta, Otsu 520-2192, Japan
| | - Kenji Kandori
- Emergency of Medicine, Critical Care Center, Kyoto Daini Red Cross Hospital, Haruobi, Kamazamarutamachi, Kamigyo, Kyoto 602-8026, Japan
| | - Michitaro Miyaguni
- Emergency of Medicine, Critical Care Center, Kyoto Daini Red Cross Hospital, Haruobi, Kamazamarutamachi, Kamigyo, Kyoto 602-8026, Japan
| | - Ryoji Iizuka
- Emergency of Medicine, Critical Care Center, Kyoto Daini Red Cross Hospital, Haruobi, Kamazamarutamachi, Kamigyo, Kyoto 602-8026, Japan
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Emergency whole-body CT scans in pediatric patients with trauma: patterns of injuries, yield of dual-phase scanning, and influence of second read on detection of injuries. Eur Radiol 2022; 32:8473-8484. [PMID: 35687137 DOI: 10.1007/s00330-022-08878-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Revised: 04/12/2022] [Accepted: 05/12/2022] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To describe injury patterns in children with multiple trauma (MT), evaluate the yield of dual-phase whole-body CT (WBCT), and quantify missed injuries detected on second reading. METHODS Remotely analyzed WBCT performed between 2011 and 2020 in 63 emergency departments on children admitted for MT were included. Second reading occurred within 24 h. Collected data included age, sex, mechanism, Injury Severity Score (ISS), radiologists' experience, time and duration of first reading, conclusion of both readings, and dosimetry. Melvin score assessed the clinical impact of missed injuries. RESULTS Overall, 1114 patients were included, 1982 injuries were described in 662 patients (59.4%), 452/1114 (40.6%) WBCT were negative, and 314 (28.2%) patients had MT (≥ 2 body parts injured). The most frequent injuries were pulmonary contusions (8.3%), costal fractures (6.2%), and Magerl A1 vertebral fractures (4.9%). Overall, 151 injuries were missed in 92 (8.3%) patients. Independent predictors for missed injuries were age ≤ 4 years (p = 0.03), number of injured body parts ≥ 2 (p = 0.01), and number of injuries ≥ 3 (p < 0.001). Melvin score grade 3 lesions were found in 16/92 (17.4%) patients with missed injuries (1.4% of all WBCT), where only prolonged follow-up was necessary. Thirteen active bleeding or pseudoaneurysms were detected (0.7% of injuries). CONCLUSION Injuries were diagnosed in 59.4% of patients. Double-reading depicted additional injuries in 8.3% of patients, significantly more in children ≤ 4 years, with ≥ 3 injuries or ≥ 2 injured body parts. As 28 % of patients had MT and 1.1% had active extravasation or pseudoaneurysm, indication for WBCT should be carefully weighted. KEY POINTS • When performed as a first-line imaging evaluation, approximately 41% of WBCT for MT children were considered normal. • The three most common injuries were pulmonary contusions, costal fractures, and Magerl A1 vertebral fractures, but the patterns of traumatic injuries on WBCT depended on the children's age and the trauma mechanism. • The independent predictors of missed injuries were age ≤ 4 years, number of body parts involved ≥ 2, and total number of injuries ≥ 3.
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Simma L, Fornaro J, Stahr N, Lehner M, Roos JE, Lima TVM. Optimising whole body computed tomography doses for paediatric trauma patients: a Swiss retrospective analysis. JOURNAL OF RADIOLOGICAL PROTECTION : OFFICIAL JOURNAL OF THE SOCIETY FOR RADIOLOGICAL PROTECTION 2022; 42:021521. [PMID: 35354135 DOI: 10.1088/1361-6498/ac6274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Accepted: 03/30/2022] [Indexed: 06/14/2023]
Abstract
We aimed to evaluate the impact of a low-dose whole-body computed tomography (WBCT) protocol on radiation doses in paediatric major trauma patients. Retrospective cohort study of paediatric trauma patients (<16 years) at a national level 1 paediatric trauma centre (PTC) over a 6 year period prior and post introduction of a low-dose WBCT protocol (2014-2019). Demographic data, patient characteristics, CT device, and exposure information including scan range, dose-length product, and volume CT dose index were collected. Effective dose (ED) and exposure parameters were compared before and after protocol introduction. Forty-eight patients underwent WBCT during the study period. Prior to introduction of the low-dose protocol (n= 18), the ED was 20.6 mSv (median 20.1 ± 5.3 mSv [range 12.5-30.7]). After introduction of the low-dose WBCT protocol (n= 30), mean ED was 4.8 mSv (median 2.6 ± 5.0 [range: 0.8-19.1]). This resulted in a reduction of 77% in mean ED (pvalue <0.001). Significant radiation dose reduction of 77% can be achieved with low-dose WBCT protocols in PTCs.
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Affiliation(s)
- Leopold Simma
- Emergency Department, Children's Hospital Lucerne, Spitalstrasse, CH-6000 Lucerne, Switzerland
- Emergency Department, University Children's Hospital Zurich, University of Zurich, Steinwiessstrasse 75, Zurich, CH 8032, Switzerland
| | - Juergen Fornaro
- Institute of Radiology and Nuclear Medicine, Cantonal Hospital Lucerne, Spitalstrasse, CH-6000 Lucerne, Switzerland
| | - Nikolai Stahr
- Institute of Radiology and Nuclear Medicine, Cantonal Hospital Lucerne, Spitalstrasse, CH-6000 Lucerne, Switzerland
- Pediatric Radiology Department, Children's Hospital Lucerne, Spitalstrasse, CH-6000 Lucerne, Switzerland
| | - Markus Lehner
- Pediatric Surgery Department, Children's Hospital Lucerne, Spitalstrasse, CH-6000 Lucerne, Switzerland
| | - Justus E Roos
- Institute of Radiology and Nuclear Medicine, Cantonal Hospital Lucerne, Spitalstrasse, CH-6000 Lucerne, Switzerland
| | - Thiago Viana Miranda Lima
- Institute of Radiology and Nuclear Medicine, Cantonal Hospital Lucerne, Spitalstrasse, CH-6000 Lucerne, Switzerland
- Institute of Radiation Physics, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland
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Dahl FA, Rama T, Hurlen P, Brekke PH, Husby H, Gundersen T, Nytrø Ø, Øvrelid L. Neural classification of Norwegian radiology reports: using NLP to detect findings in CT-scans of children. BMC Med Inform Decis Mak 2021; 21:84. [PMID: 33663479 PMCID: PMC7934405 DOI: 10.1186/s12911-021-01451-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Accepted: 02/21/2021] [Indexed: 12/20/2022] Open
Abstract
Background With a motivation of quality assurance, machine learning techniques were trained to classify Norwegian radiology reports of paediatric CT examinations according to their description of abnormal findings. Methods 13.506 reports from CT-scans of children, 1000 reports from CT scan of adults and 1000 reports from X-ray examination of adults were classified as positive or negative by a radiologist, according to the presence of abnormal findings. Inter-rater reliability was evaluated by comparison with a clinician’s classifications of 500 reports. Test–retest reliability of the radiologist was performed on the same 500 reports. A convolutional neural network model (CNN), a bidirectional recurrent neural network model (bi-LSTM) and a support vector machine model (SVM) were trained on a random selection of the children’s data set. Models were evaluated on the remaining CT-children reports and the adult data sets. Results Test–retest reliability: Cohen’s Kappa = 0.86 and F1 = 0.919. Inter-rater reliability: Kappa = 0.80 and F1 = 0.885. Model performances on the Children-CT data were as follows. CNN: (AUC = 0.981, F1 = 0.930), bi-LSTM: (AUC = 0.978, F1 = 0.927), SVM: (AUC = 0.975, F1 = 0.912). On the adult data sets, the models had AUC around 0.95 and F1 around 0.91. Conclusions The models performed close to perfectly on its defined domain, and also performed convincingly on reports pertaining to a different patient group and a different modality. The models were deemed suitable for classifying radiology reports for future quality assurance purposes, where the fraction of the examinations with abnormal findings for different sub-groups of patients is a parameter of interest.
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Affiliation(s)
- Fredrik A Dahl
- Health Services Research Unit, Akershus University Hospital, Lørenskog, Norway. .,Institute for Clinical Medicine, Campus Ahus, University of Oslo, Oslo, Norway.
| | - Taraka Rama
- Department of Linguistics, University of North Texas, Denton, TX, USA
| | - Petter Hurlen
- Division of Diagnostics and Technology, Akershus University Hospital, Lørenskog, Norway
| | - Pål H Brekke
- Department of Cardiology, Oslo University Hospital Rikshospitalet, Oslo, Norway
| | - Haldor Husby
- Institute for Clinical Medicine, Campus Ahus, University of Oslo, Oslo, Norway
| | - Tore Gundersen
- Data and Analytics, Akershus University Hospital, Lørenskog, Norway
| | - Øystein Nytrø
- Department of Computer Science, Norwegian University of Science and Technology, Trondheim, Norway
| | - Lilja Øvrelid
- Department of Informatics, University of Oslo, Oslo, Norway
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Ali A, Tatum D, Jones G, Guidry C, McGrew P, Schroll R, Harris C, Duchesne J, Taghavi S. Computed Tomography for Pediatric Pelvic Fractures in Pediatric Versus Adult Trauma Centers. J Surg Res 2020; 259:47-54. [PMID: 33279844 DOI: 10.1016/j.jss.2020.11.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Revised: 10/08/2020] [Accepted: 11/02/2020] [Indexed: 11/15/2022]
Abstract
BACKGROUND Pediatric pelvic fractures are a significant source of morbidity for children in the United States. In the era of specialized care, the relationship between trauma center designation and outcomes remains unknown. We hypothesized that there would be no difference in patient outcomes when treated at adult trauma centers (ATCs), pediatric trauma centers (PTCs), or dual trauma centers (DTCs). MATERIALS AND METHODS We used the National Trauma Data Bank to identify pediatric (≤14 y) patients suffering pelvic fractures in 2013-2015. DTCs were defined as centers with level I or II trauma designation for both pediatric and adult care. Primary outcomes included mortality, complications, and computed tomography (CT) utilization. RESULTS There were 4260 patients who met study criteria. Of these, 1290 (22%) were treated at ATCs, 1332 (30%) at PTCs, and 2120 (48%) at DTCs. Pediatric patients treated at ATCs were more likely to suffer a complication or receive a CT scan. On multivariate analysis, patients treated at PTCs and DTCs were significantly less likely to have a recorded complication or receive head, thoracic, or whole-body CT scans compared with ATCs. DTCs, but not PTCs, used fewer abdominal CT scans. Mortality rates were not predicted by center designation. CONCLUSIONS For pediatric pelvic fractures, centers with pediatric trauma designation (PTCs and DTCs) appear to have better outcomes despite significantly less use of CT scans. Further studies are needed to determine optimal management of pediatric pelvic fractures while minimizing exposure to ionizing radiation. LEVEL OF EVIDENCE Level III Retrospective.
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Affiliation(s)
- Ayman Ali
- Tulane University School of Medicine, New Orleans, Louisiana
| | | | - Glenn Jones
- LSU Health - Baton Rouge, Baton Rouge, Lousiana
| | - Chrissy Guidry
- Tulane University School of Medicine, New Orleans, Louisiana
| | - Patrick McGrew
- Tulane University School of Medicine, New Orleans, Louisiana
| | - Rebecca Schroll
- Tulane University School of Medicine, New Orleans, Louisiana
| | - Charles Harris
- Tulane University School of Medicine, New Orleans, Louisiana
| | - Juan Duchesne
- Tulane University School of Medicine, New Orleans, Louisiana
| | - Sharven Taghavi
- Tulane University School of Medicine, New Orleans, Louisiana.
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Hassan N, Butler C, DeCou J, Crumb T, Flohr S, Reischman D, Junewick J. Pediatric cervical spine injuries on CT: difference in accuracy of interpretations by pediatric versus non-pediatric radiologists. Emerg Radiol 2019; 27:185-190. [PMID: 31820269 DOI: 10.1007/s10140-019-01743-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Accepted: 11/01/2019] [Indexed: 11/29/2022]
Abstract
PURPOSE To retrospectively compare the accuracy of interpretation of initial cervical computerized tomography (CCT) by a non-pediatric radiologist (NPR) versus a pediatric radiologist (PR). METHODS IRB approval and consent waiver were granted to review all injured children from 2010 to 2014 in the trauma registry with CT and magnetic resonance imaging (MRI) of the cervical spine. Patients with negative CCT who subsequently had positive MRI from a single institution comprised the study group. Patients with negative CCT and MRI, matched by age, gender, and severity scores, comprised the control group. The CCTs from both groups were initially interpreted at the time of service by a NPR. Subsequently, a single PR with 20 years of experience blinded to clinical/imaging data reinterpreted these CCT examinations. CT interpretations were then compared with MRI results and evaluated for statistical significance using SSPS software. The data analysis utilized summary statistics, two-tailed binomial test, and univariate χ2 test. Significance for all comparisons was assessed at P < 0.05. RESULTS The study group was comprised of the 21 patients with negative CCT and positive MRI. Of the cohort included, 76% (16) were male and 24% (5) were female. The age range was 1 month-17 years, with a mean age of 9.7 years. CCT interpretation by NPR had a specificity of 91.7% (sensitivity 71.2%, positive predictive value 81.3%, and negative predictive value 86.3%) compared with results of MRI. Six of the 21 negative CCTs were interpreted by the PR as positive, mainly craniocervical junction injuries, and confirmed by MRI (28.6%, P < .001 compared with the NPR); no control CCT was interpreted by the PR as positive (sensitivity 100%, positive predictive value 100%, and negative predictive value 58.3%). CONCLUSION In our retrospective study, a pediatric radiologist has improved recognition of pediatric cervical spine injuries on CT compared with non-pediatric radiologist.
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Affiliation(s)
- Nabil Hassan
- Division of Pediatric Critical Care, OSF Healthcare Children's Hospital of Illinois, 530 NE Glen Oak Ave, Peoria, IL, 61637, USA
| | - Chloe Butler
- Mercy Medical Center, P.O. Box 14584, Des Moines, IA, 50306-3584, USA
| | - James DeCou
- Department of Surgery, Helen DeVos Children's Hospital, 100 Michigan St. NE, Grand Rapids, MI, 49503, USA
| | - Teri Crumb
- Department of Surgery, Helen DeVos Children's Hospital, 100 Michigan St. NE, Grand Rapids, MI, 49503, USA
| | - Stephanie Flohr
- Department of Surgery, Helen DeVos Children's Hospital, 100 Michigan St. NE, Grand Rapids, MI, 49503, USA
| | - Diann Reischman
- Department of Epidemiology, Grand Valley State University, A-1-178 Mackinac Hall, Allendale, MI, 49401, USA
| | - Joseph Junewick
- Advanced Radiology Services PC, Grand Rapids, MI, USA. .,Michigan State University College of Human Medicine, Grand Rapids, MI, USA. .,Department of Radiology, Helen DeVos Children's Hospital, 100 Michigan Street, Grand Rapids, MI, 49503, USA.
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Vogl TJ, Eichler K, Marzi I, Wutzler S, Zacharowski K, Frellessen C. [Imaging techniques in modern trauma diagnostics]. Med Klin Intensivmed Notfmed 2019; 112:643-657. [PMID: 28936574 DOI: 10.1007/s00063-017-0359-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Modern trauma room management requires interdisciplinary teamwork and synchronous communication between a team of anaesthesists, surgeons and radiologists. As the length of stay in the trauma room influences morbidity and mortality of a severely injured person, optimizing time is one of the main targets. With the direct involvement of modern imaging techniques the injuries caused by trauma should be detected within a very short period of time in order to enable a priority-orientated treatment. Radiology influences structure and process quality, management and development of trauma room algorithms regarding the use of imaging techniques. For the individual case interventional therapy methods can be added. Based on current data and on the Frankfurt experience the current diagnostic concepts of trauma diagnostics are presented.
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Affiliation(s)
- T J Vogl
- Institut für Diagnostische und Interventionelle Radiologie, Universitätsklinikum Frankfurt, Johann Wolfgang Goethe-Universität, Theodor-Stern-Kai 7, 60590, Frankfurt, Deutschland.
| | - K Eichler
- Institut für Diagnostische und Interventionelle Radiologie, Universitätsklinikum Frankfurt, Johann Wolfgang Goethe-Universität, Theodor-Stern-Kai 7, 60590, Frankfurt, Deutschland
| | - I Marzi
- Zentrum der Chirurgie, Klinik für Unfall-, Hand- und Wiederherstellungschirurgie, Universitätsklinikum Frankfurt, Johann Wolfgang Goethe-Universität, Frankfurt, Deutschland
| | - S Wutzler
- Zentrum der Chirurgie, Klinik für Unfall-, Hand- und Wiederherstellungschirurgie, Universitätsklinikum Frankfurt, Johann Wolfgang Goethe-Universität, Frankfurt, Deutschland
| | - K Zacharowski
- Klinik für Anästhesiologie, Intensivmedizin und Schmerztherapie, Universitätsklinikum Frankfurt, Johann Wolfgang Goethe-Universität, Frankfurt, Deutschland
| | - C Frellessen
- Institut für Diagnostische und Interventionelle Radiologie, Universitätsklinikum Frankfurt, Johann Wolfgang Goethe-Universität, Theodor-Stern-Kai 7, 60590, Frankfurt, Deutschland
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Vogl TJ, Eichler K, Marzi I, Wutzler S, Zacharowski K, Frellessen C. [Imaging techniques in modern trauma diagnostics]. Unfallchirurg 2018; 120:417-431. [PMID: 28455618 DOI: 10.1007/s00113-017-0352-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Modern trauma room management requires interdisciplinary teamwork and synchronous communication between a team of anaesthesists, surgeons and radiologists. As the length of stay in the trauma room influences morbidity and mortality of a severely injured person, optimizing time is one of the main targets. With the direct involvement of modern imaging techniques the injuries caused by trauma should be detected within a very short period of time in order to enable a priority-orientated treatment. Radiology influences structure and process quality, management and development of trauma room algorithms regarding the use of imaging techniques. For the individual case interventional therapy methods can be added. Based on current data and on the Frankfurt experience the current diagnostic concepts of trauma diagnostics are presented.
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Affiliation(s)
- T J Vogl
- Institut für Diagnostische und Interventionelle Radiologie, Universitätsklinikum Frankfurt, Johann Wolfgang Goethe-Universität, Theodor-Stern-Kai 7, 60590, Frankfurt, Deutschland.
| | - K Eichler
- Institut für Diagnostische und Interventionelle Radiologie, Universitätsklinikum Frankfurt, Johann Wolfgang Goethe-Universität, Theodor-Stern-Kai 7, 60590, Frankfurt, Deutschland
| | - I Marzi
- Zentrum der Chirurgie, Klinik für Unfall-, Hand- und Wiederherstellungschirurgie, Universitätsklinikum Frankfurt, Johann Wolfgang Goethe-Universität, Frankfurt, Deutschland
| | - S Wutzler
- Zentrum der Chirurgie, Klinik für Unfall-, Hand- und Wiederherstellungschirurgie, Universitätsklinikum Frankfurt, Johann Wolfgang Goethe-Universität, Frankfurt, Deutschland
| | - K Zacharowski
- Klinik für Anästhesiologie, Intensivmedizin und Schmerztherapie, Universitätsklinikum Frankfurt, Johann Wolfgang Goethe-Universität, Frankfurt, Deutschland
| | - C Frellessen
- Institut für Diagnostische und Interventionelle Radiologie, Universitätsklinikum Frankfurt, Johann Wolfgang Goethe-Universität, Theodor-Stern-Kai 7, 60590, Frankfurt, Deutschland
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Bildgebende Verfahren der modernen Schockraumdiagnostik. Notf Rett Med 2017. [DOI: 10.1007/s10049-017-0376-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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