Sustaining the gains: Reducing unnecessary computed tomography scans in pediatric trauma patients

• Published in: Journal of pediatric surgery 2023-01, Vol.58 (1), p.111-117
• Main Authors: Mahdi, Elaa, Toscano, Nicole, Pierson, Lauren, Ndikumana, Eric, Ayers, Brian, Chacon, Alexander, Brayer, Anne, Chess, Mitchell, Davis, Colleen, Dorman, Robert, Livingston, Michael, Arca, Marjorie, Wakeman, Derek
• Format: Article
• Language: English
• Subjects: Child; Computed tomography imaging; Humans; Implementation science; Injured children; Pediatric blunt trauma; Practice Guidelines as Topic; Quality improvement; Radiation Exposure - prevention & control; Radiation stewardship; Tomography, X-Ray Computed - statistics & numerical data; Trauma Centers; Unnecessary Procedures; Wounds, Nonpenetrating - diagnostic imaging; Wounds, Nonpenetrating - therapy
• ISSN: 0022-3468; 1531-5037
• DOI: 10.1016/j.jpedsurg.2022.09.027

•What is known about this topic? CT imaging in children can cause radiation-induced malignancies later in life. Guidelines can assist providers in determining imaging indicated for injured children.•What new information is contained in this article? Quality improvement and implementation science methodologies enhance guideline implementation efforts. Prospectively tracking adherence and iterative process improvement efforts can sustain and further improve guideline compliance over time. “Pan-scanning” pediatric blunt trauma patients leads to exposure to harmful radiation and increased healthcare costs without improving outcomes. We aimed to reduce computed tomography (CT) scans that are not indicated (NI) by imaging guidelines for injured children. In July 2017, our Pediatric Trauma Center prospectively implemented validated imaging guidelines to direct CT imaging for trauma activations and consultations for children younger than 16 years old with blunt traumatic injuries. Patients with suspected physical abuse, CT imaging prior to arrival, penetrating mechanism, and instability precluding CT imaging were excluded. We compared CT scanning rates for pre-implementation (01/2016–06/2017) and post-implementation (07/2017–08/2021) time periods. Guideline compliance was evaluated by chart review and sustained through iterative process improvement cycles. During the pre-implementation era, 61 patients underwent 171 CT scans of which 87 (51%) scans were not indicated by guidelines. Post-implementation, 363 patients had 531 scans and only 134 (25%) CTs were not indicated. Total CTs performed declined after initiation of guidelines (2.80 vs 1.46 scans/patient, p