A new study shows how emergency department physicians can avoid needless diagnostic computed tomography (CT) scanning of children with abdominal injuries. Researchers who developed a decision support tool say their findings could prevent many vulnerable children from being unnecessarily exposed to medical radiation.
Between 5 million and 9 million CT scans are performed on US children annually, according to the National Cancer Institute. The scans can save lives, but with annual growth in the number of CT scans estimated at 10%, they’re now the top contributor to medical radiation exposure in the United States.
Published online today in the Annals of Emergency Medicine, the study describes 7 clinical criteria that accurately predicted which children arriving in emergency departments with blunt torso trauma didn’t have injuries severe enough to require a diagnostic CT scan.
The team of researchers studied 12 044 children treated in 20 emergency departments throughout the country for abdominal injuries sustained in car crashes, falls, bicycle collisions, and other circumstances. Their statistical analysis showed 7 signs or symptoms that correlate most closely with having a severe injury that requires immediate attention: outward signs of abdominal or chest trauma (such as a seat-belt abrasion), Glasgow Coma Score of less than 14, abdominal tenderness, abdominal pain, evidence of chest wall trauma, decreased breath sounds, and vomiting.
Further, the findings showed that children with none of these signs or symptoms had only a 0.1% chance of having injuries serious enough to need acute care. “Therefore, abdominal CT is generally not warranted for them,” the authors wrote. In their study population, 23% of abdominal scans were performed in these very low–risk children.
“We have now identified a population of pediatric patients that does not typically benefit from a CT scan, which is an important step in reducing radiation exposure,” lead author James Holmes, MD, MPH, of the University of California Davis School of Medicine, said in a statement.
Holmes and his colleagues wrote that the decision tool should be validated in another trial and that it’s intended for use to rule out the need for CT scans rather than determine when scans are required.