In major adult blunt trauma, there are still two factions: those who pan-scan for diagnosis, and those who use CT selectively. The pan-scan proponents argue that they find everything, including things that would have been missed with selective scanning. The selective scanners argue that those things are typically not clinically significant, and radiation exposure is reduced.
Who is right? We’re still not sure. But when it comes to children, most believe that less radiation is always better. The group at USC decided to look at their experience with pan-scan vs selective imaging in blunt pediatric trauma patients, defined as those < 16 years of age. They reviewed their experience over a three year period, excluding those who had low blood pressure (<90). A total of 648 children met these criteria, and an array of variables were analyzed to try to determine “superiority.”
Here are the factoids:
- 88% of these patients had low injury severity (ISS < 15), 567 patients
- The low severity group who were selectively scanned had a half-day decrease in length of stay*, a quarter-day decrease in ventilator days, lower morbidity (15% vs 24%)*, and radiation exposure (8 vs 18 mSv)*, with the asterisked variables being “statistically significant”
- The high severity also showed positive differences in decreased ICU length of stay, ventilator days, morbidity*, and radiation exposure*
- For both pan- and selective-scanning, additional imaging led to no additional interventions in 95% of cases
Bottom line: Ugh! This is not a good abstract. It shows association, but not causation with anything but the radiation exposure calculations. Yes, if you scan less in the selective arm, there better be less exposure. But the other variables are either not clinically significant, or not defined well (i.e. morbidity).
The authors conclude that selective scanning is the way to go based on this (extremely weak) data. This is why I always recommend that you read the whole paper, not just the abstract, or in this case the whole abstract and not just the conclusion. The data, as presented in this abstract, do not support this at all.
The authors don’t say how many of these patients were very young, and how many of them actually received pan-scans. But any pediatric trauma surgeon would cringe if they read this article. Although you may be a big believer in pan-scanning, reserve it for adults only until we have some better data. Don’t irradiate kids unnecessarily!
Reference: Selective CT imaging is superior to liberal CT imaging in the hemodynamically normal pediatric blunt trauma patient. JACS 225(4S1):562, 2017.