Analysis of radiation exposure among pediatric trauma patients at national trauma centers.

BACKGROUND: Injured children undergo radiologic studies as part of trauma evaluations. Children are more sensitive than adult patients to the effects of ionizing radiation. Few studies have described the radiation exposure to pediatric patients during trauma evaluations. We sought to describe the rate of use of radiology studies and to estimate the effective dose of radiation delivered to pediatric trauma patients presenting to trauma centers within the United States.

METHODS: We performed an analysis of pediatric patients younger than 19 years who presented to an American College of Surgery-verified trauma center in 2010 (National Trauma Data Bank). We excluded patients who were transferred from another facility, patients who died at the scene or those who presented to the emergency department dead on arrival. We examined the use of computed tomography (CT) and standard radiographs (x-ray). Radiologic studies were identified through common procedure codes (CPT). Using published criteria, we estimated the effective radiation dose per trauma patient.

RESULTS: Among the 84,863 eligible pediatric trauma patients, 26,360 (31.1%) underwent imaging with x-ray or CT. Of these patients, 17,321 (65.7%) were male, median age was 13.0 years (interquartile range, 6.0-17.0), and 20,965 (79.5%) had an Injury Severity Score (ISS) of less than 16. A total of 23,148 (27.4%) underwent CT. X-ray studies accounted for a small amount of exposure to radiation as compared with CT. Mean (SD) effective radiation exposure of patients imaged with CT was 12.0 (8.2) mSv. Younger children and those with increasing injury severity were exposed to higher doses of radiation (β = -0.04, p < 0.001).

CONCLUSION: The majority of radiation exposure to pediatric trauma patients is secondary to CT. Younger children and those with more severe injuries are exposed to higher doses of radiation. Pediatric trauma patients are exposed to levels of radiation, which could potentially lead to long-term harm.

LEVEL OF EVIDENCE: Epidemiologic study, level III.