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A STUDY TO ASSESS WHETHER THE CLINICAL BACKGROUND OF A PAEDIATRIC TRAUMA TEAM LEADER AFFECTS THEIR CHOICE OF IMAGING MODALITY IN COMPARABLE TRAUMA PATIENTS
  1. E Thorpe,
  2. K A Mcleod,
  3. M Vaidya
  1. The Royal London Hospital, London, United Kingdom

Abstract

Objectives & Background Paediatric trauma team leaders (TTL) may be trained in different clinical sub specialties. The purpose of this study was to compare TTL trained in adult and paediatric emergency medicine in ordering pan CT scans in a similar category of trauma patient. Radiation doses received are often extremely high and carry with them a significantly increased risk for the child of developing cancer in the future.

Methods A retrospective review of the case notes of 455 consecutive paediatric trauma patients aged 15 and younger between January 2010 and December 2012 at a London based tertiary paediatric trauma centre. 116 patients were identified whose mechanism of injury was pedestrian versus car (>10 MPH). The training background of the trauma team leader (TTL) in each case was identified and imaging recorded. The ISS (Injury Severity Scores) and the clinical yield of each pan scan were analysed.

Results 116 patients were identified whose mechanism of injury was pedestrian versus car (>10 MPH). 67 of these patients (58%) had a consultant TTL trained in adult emergency medicine (EM). 49 of the patients (42%) had a consultant TTL trained in paediatric emergency Medicine (PEM). Of the traumas lead by EM TTLs, 14 (21%) had an ISS >16 (polytrauma) and 26 (39%) had ISS <5. A total of 36 (54%) cases received a pan CT scan.15 patients (42%) required clinical intervention including admission to ICU for observation. The remaining patients (58%) were either managed for injuries identified on plain films or did not require medical management for their injuries. Of the traumas lead by PEM TTLs, 14 (28%) had an ISS >16 (polytrauma) and 17 (34%) had ISS <5. A total of 24 (49%) cases received a pan CT scan. 15 patients (62%) required clinical intervention including admission to ICU for observation. The remaining patients (38%) were either managed for injuries identified on plain films or did not require medical management for their injuries.

Conclusion Trauma team leaders from paediatric and adult emergency background have a similar propensity to order CT pan scans in trauma. Regardless of who the TTL was, the overall yield of the CT pan scans was only 50%, so the need for weighing up the risks/benefits is imperative in this group.

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