Keywords:
Paediatric, Radioprotection / Radiation dose, Trauma, CT, Radiation safety, Acute, Quality assurance
Authors:
S. Gentile, L. Borgwardt, L. H. Andersen, O. Rosenkrantz, S. S. Rudolph, C. Ewertsen
DOI:
10.26044/esi2024/ESI-13670
Results or findings
A total of 544 patients were included in the full cohort, of which 429 (79%) were primary admissions to our trauma center and included in this analysis. The median age was 11 years (IQR: 3-15), and 35% were girls. The three most common injury mechanisms were motor vehicle accident (34%), fall from height (33%) and struck/hit by blunt object (12%) (fig. 1).
50 patients (12%) did not undergo CT. Among all 429 patients, full body trauma CT was performed in 258 patients (60%), CT of the brain and cervical spine in 45 (10%), CT of the thorax-abdomen in 34 (8%), brain CT in 22 (5%), CT of the abdomen in 5 (1.2%), while 15 patients underwent other combinations (e.g. CT of the cervical spine and thorax) (fig. 2).
Among patients involved in motor vehicle accidents who had a full body trauma CT, 40 (31%) did not present any injury, while 56 (43%) were injured in only one body region and 33 (26%) were injured in two or more regions (fig. 3).
The same trend was seen for the other injury mechanisms.
Compared to the European DRLs, the radiation doses for brain CT were not significantly different from the reference level in the age group 1-6 years (p = 0.956), while doses were significantly higher in the oldest age group (p < 0.0001) (fig. 4).
This might be due to the selective trauma population presented in our study and the frequent use of supplementary facial bone CT.
The values for CT thorax-abdomen were slightly, yet significantly, lower both for the weight groups 5-14 kg. (p < 0.0001) and 15-29 kg. (p = 0.0008) (fig. 4). The older patients received slightly, yet significantly, higher doses than the reference levels with p < 0.0001 for the weight group 30-49 kg. and p < 0.010 for the weight group 50-79 kg. This was in part due to some patients having supplemental contrast phases, possible cervical CT angiography dose registered under the CT thorax-abdomen and some patients having a body composition with large muscles or being obese. Also, the general quality of the trauma protocols was higher than other follow-up CTs.
Strengths of our study include large population covering four years, recent data as well as reliable data from our local trauma register used for quality assurance. Our study also has limitations such as few included patients in the youngest age group and area-specific doses unavailable in some patients.