Adapting pediatric CT guidelines around four anatomical areas allowed researchers in New York to cut unnecessary imaging in half, while sparing children from unnecessary radiation and its associated risks, without missing clinically significant injuries.

Clinicians at the Pediatric Trauma Center at UR Medicine Golisano Children’s Hospital (GCH) orchestrated one of the first large-scale hospital initiatives to reduce unnecessary pediatric CT imaging on injured children by adapting existing guidelines for head, neck and abdomen/pelvis, and developing new ones for the chest area that were integrated into the technological process.

This enabled alternative means of diagnosis that not only limited exposure but reduced healthcare costs without negatively affecting outcomes, according to Dr. Derek Wakeman, associate professor in the departments of surgery and pediatrics. The GCH clinical team also continued to use best practices for different areas of the body.
“If a child is awake and alert, we don’t necessarily need a CT scan to determine concussion risk. If blood work looks normal and the child does not have significant abdominal pain, we can often omit an abdominal CT. For possible cervical spine injuries, X-rays can help pick up significant injuries,” he said.

Because of their smaller size and different anatomies, children face a greater chance of injury from radiation than adults, with a one in one thousand risk of developing a fatal tumor later in life, according to the National Institutes of Health’s National Cancer Institute.

Prior to the changes (January 2016 to June 2017), 61 patients underwent 171 CT scans, of which 87 (51%) were not necessary according to guidelines. Following the period when the new guidelines were implemented (July 2017 to August 2021), 363 had 531 scans, with 134 not needed, a more than 25% reduction.

An estimated 146 children avoided excessive radiation, as a result, with no clinically significant injuries missed. Additionally, scanning charges in the ED dropped from $1,490.31 per patient to $408.21, an estimated total savings of $218,000.

“It reduces a lot of waste in the system and more importantly minimizes exposure to radiation, as young children are at a much greater risk of injury from this exposure than adults,” said Wakeman.

The findings were published in the Journal of Pediatric Surgery.

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