1) The study analyzed over 30,000 pediatric trauma patients treated at level I or II adult or pediatric trauma centers to compare the use of whole body CT (WBCT) scans between facilities.
2) It found WBCT scans were used significantly more often on pediatric patients treated at adult trauma centers (31.4%) compared to pediatric centers (17.6%).
3) After adjusting for factors, pediatric patients treated at adult centers were 1.8 times more likely to receive a WBCT, increasing their radiation risk without improving outcomes, as mortality did not differ between the groups. The study concludes guidelines are needed to minimize unnecessary WBCT use across centers.
The management of painful bone metastases requires multidisciplinary care, with external beam radiation therapy (EBRT) providing relief that is effective and time efficient.
In our study the efficacy of external beam irradiation in the palliation of bone metastasis-related symptoms is confirmed by this study, even with short treatments and single-dose administrations. This is important for both patient expectations and the necessity for improved resource allocation with reference to the territorial distribution and waiting lists of radiotherapy centers. The issue of their efficacy in combination with antiblastic drugs (Bisphosphonates drugs such as Zoledronic acid) and/or external beam irradiation(EBRT) remains open and will be clarified only with further randomized clinical trials.
Background: The transition from resident physician to independent practitioner is an important period for young physicians.Optimally, they would feel well prepared to independently care for all patients presenting to them for anesthesia, however, this is unlikely Methods: A survey was emailed to all accredited anesthesiology residency program coordinators in April 2018 for further distribution to their CA3 residents. The survey collected data on the resident’s perception of his or her preparedness to manage a variety of anesthesia cases, patients with comorbid conditions, and ethical issues as well as perform various procedures.
Please see the Creative Commons License on the second slide. This slide deck is for medical education uses only and does not constitute medical advice. Please consult with your own health care provider.
Background: There is a global resolve among Clinicians towards adoption of imaging modalities in the evaluation of appendicitis because clinical algorithms have been disappointing. We sought to determine the authenticity of interobserver variability in ultrasound scan interpretation in a resourceconstrained mission hospital settings, northwestern region of Cameroon. Methods: In this study, we reviewed the standardized diagnostic approach in acute appendicitis and also performed prospective cross observational qualitative testing using sensitivity, specifi city, positive predictive value, negative predictive value, and accuracy to determine the interobserver variability of ultrasonography using the medical database of the two Mission Hospitals, northwestern region of Cameroon from January 2012 to December 2016. A sequential non-randomized convenient sampling was used and data was analyzed using the Statistical Package for the Social Sciences version 22.
40%-80% of auto accident claimants have overlooked diagnoses. The most commonly overlooked are thoracic outlet syndrome, cervical disc damage mistakenly called sprain or whiplash, post-concussion syndrome, slipping rib syndrome, Tietze syndrome and Tempro-mandibular joint syndrome. This article tells readers the clinical sign and symptoms of each and the correct medical tests to use, which are employed by doctors at Johns Hopkins Hospital. It also described an on-line questionnaire at www.DiagnoseThePains.com which gives diagnoses with a 96% correlation with diagnoses of Johns Hopkins Hospital doctors.
Missed Diagnoses association in Rear end collisions Nelson Hendler
There are a number of overlooked diagnoses which occur after a rear-end accident. This paper shows an attorney how to convert a misdiagnosed 'soft tissue injury case" into damaged cervical disc,TMJ, thoracic outlet syndrome,and post concussion syndrome using a diagnostic paradigm to get diagnoses with a 96% correlation with diagnoses of Johns Hopkins Hospital doctors. This improves patient care and increases recovery.
The management of painful bone metastases requires multidisciplinary care, with external beam radiation therapy (EBRT) providing relief that is effective and time efficient.
In our study the efficacy of external beam irradiation in the palliation of bone metastasis-related symptoms is confirmed by this study, even with short treatments and single-dose administrations. This is important for both patient expectations and the necessity for improved resource allocation with reference to the territorial distribution and waiting lists of radiotherapy centers. The issue of their efficacy in combination with antiblastic drugs (Bisphosphonates drugs such as Zoledronic acid) and/or external beam irradiation(EBRT) remains open and will be clarified only with further randomized clinical trials.
Background: The transition from resident physician to independent practitioner is an important period for young physicians.Optimally, they would feel well prepared to independently care for all patients presenting to them for anesthesia, however, this is unlikely Methods: A survey was emailed to all accredited anesthesiology residency program coordinators in April 2018 for further distribution to their CA3 residents. The survey collected data on the resident’s perception of his or her preparedness to manage a variety of anesthesia cases, patients with comorbid conditions, and ethical issues as well as perform various procedures.
Please see the Creative Commons License on the second slide. This slide deck is for medical education uses only and does not constitute medical advice. Please consult with your own health care provider.
Background: There is a global resolve among Clinicians towards adoption of imaging modalities in the evaluation of appendicitis because clinical algorithms have been disappointing. We sought to determine the authenticity of interobserver variability in ultrasound scan interpretation in a resourceconstrained mission hospital settings, northwestern region of Cameroon. Methods: In this study, we reviewed the standardized diagnostic approach in acute appendicitis and also performed prospective cross observational qualitative testing using sensitivity, specifi city, positive predictive value, negative predictive value, and accuracy to determine the interobserver variability of ultrasonography using the medical database of the two Mission Hospitals, northwestern region of Cameroon from January 2012 to December 2016. A sequential non-randomized convenient sampling was used and data was analyzed using the Statistical Package for the Social Sciences version 22.
40%-80% of auto accident claimants have overlooked diagnoses. The most commonly overlooked are thoracic outlet syndrome, cervical disc damage mistakenly called sprain or whiplash, post-concussion syndrome, slipping rib syndrome, Tietze syndrome and Tempro-mandibular joint syndrome. This article tells readers the clinical sign and symptoms of each and the correct medical tests to use, which are employed by doctors at Johns Hopkins Hospital. It also described an on-line questionnaire at www.DiagnoseThePains.com which gives diagnoses with a 96% correlation with diagnoses of Johns Hopkins Hospital doctors.
Missed Diagnoses association in Rear end collisions Nelson Hendler
There are a number of overlooked diagnoses which occur after a rear-end accident. This paper shows an attorney how to convert a misdiagnosed 'soft tissue injury case" into damaged cervical disc,TMJ, thoracic outlet syndrome,and post concussion syndrome using a diagnostic paradigm to get diagnoses with a 96% correlation with diagnoses of Johns Hopkins Hospital doctors. This improves patient care and increases recovery.
مركز دلني - الاستثمار في قطاع تجزئة الاتصالات مشاركة في لقاء رحلة الابداع-ن...Mansour AlObaid
محاضرة قدمت في لقاء ديوانية رحلة الابداع حضرها اكثر من 850 شخص - خاصة بالاستثمار في قطاع تجزئة الاتصالات - وعرض مختصر عن خدمات مركز دلني للاعمال للمنشآت الصغيرة و المتوسطة ودوره في نشاط سعودة فطاع الاتصالات - السعودية
اول مركز طبى على اكبر مساحه بالتجمع الخامس بمركز خدمات النرجس عمارات استلام سوبر لوكس ومساحات تبدا من 37م الاستثمار بجد مع الاستلام ضعف الثمن والايجار يبدا من 300ج المتر اليوم
Study on Physicians Request for Computed Tomography Examinations for Patients...IRJESJOURNAL
Background and objectives: There is a lot controversy about the use of Computed tomography (CT) for patients with minor head injury. We aimed to determine the practice of guiding rules for the safety of radiation and increasing awareness of physicians about risks of ionizing radiation and find out the reasons of emergency doctors for sending head injury patients to CT scan exams. Materials and Methods: A descriptive questionnaire in the Emergency Department (ED) based study was performed to assess physicians' knowledge of radiation doses received from radiological treatments and knowledge about Clinic Decision Support rules (CDS). The questionnaire consisted of 26 questions distributed to physicians working in the emergency department in six hospitals in East Java. Finally, the data collected have been analyzed by some tests using SPSS version 15 and Smart PLS. Results: In this study 44 participants had taken part. The percentage of general knowledge and awareness that shows the response of people who work in the emergency departments was total 44 respondents, by percent 6.8% of the respondents had passably knowledge, awareness and 84.1% they were having a good knowledge and awareness and 9.1% the respondents had very good knowledge and awareness. That means almost of respondents have good knowledge and awareness. To find out if an indicator is forming a construct (latent variables) testing the convergent validity of the measurement model with a reflexive indicator assessed based on the correlation between the item score to construct scores were calculated with the help of software Smart PLS. Size reflexive considered valid if the individual has a correlation (loading) to construct (latent variables) to be measured ≥ 0.5 or the value of t-statistics should ≥1.96 (test two tailed) at a significance level of α = 0.05. If one of the indicators has a leading value <0.5,><1.96, then the indicator should be discarded (dropped) because it indicates that the indicators are not good enough to measure the construct in right. The positive influence between general knowledge and awareness against to knowledge about radiation doses can be interpreted that the better general knowledge and awareness, then it will be followed by an increase in their knowledge about radiation doses. And vice versa, the worse general knowledge and awareness, then this will decrease their knowledge about radiation doses too. Conclusion: The present study has illustrated that the level of awareness and knowledge physicians who deal with ionizing radiation in CT scan units are adequate overall. There is a good influence between the diligence in applying the principles of guidance and rules stipulated by the nuclear energy in Indonesia by physicians to adjust the use of CT in the emergency department, the majority of participants who have a good awareness & knowledge, there are some of them do not have enough knowledge.
Casemix, management, and mortality of patients receiving emergency neurosurge...Ahmad Ozair
Our study included 1635 records from 159 hospitals in 57 countries, collected between Nov 1, 2018, and Jan 31, 2020. 328 (20%) records were from countries in the very high HDI tier, 539 (33%) from countries in the high HDI tier, 614 (38%) from countries in the medium HDI tier, and 154 (9%) from countries in the low HDI tier. The median age was 35 years (IQR 24–51), with the oldest patients in the very high HDI tier (median 54 years, IQR 34–69) and the youngest in the low HDI tier (median 28 years, IQR 20–38). The most common procedures were elevation of a depressed skull fracture in the low HDI tier (69 [45%]), evacuation of a supratentorial extradural haematoma in the medium HDI tier (189 [31%]) and high HDI tier (173 [32%]), and evacuation of a supratentorial acute subdural haematoma in the very high HDI tier (155 [47%]). Median time from injury to surgery was 13 h (IQR 6–32). Overall mortality was 18% (299 of 1635). After adjustment for casemix, the odds of mortality were greater in the medium HDI tier (odds ratio [OR] 2·84, 95% CI 1·55–5·2) and high HDI tier (2·26, 1·23–4·15), but not the low HDI tier (1·66, 0·61–4·46), relative to the very high HDI tier. There was significant between-hospital variation in mortality (median OR 2·04, 95% CI 1·17–2·49).
Assessing the appropriateness of CT scans among pediatric ortho patientsImage gently
Sifting through peer-reviewed studies on different options in imaging technology used in pediatric orthopedic injuries, the two doctors quantified the amount of radiation in each of the CT scans radiation and X-rays for spines, pelvis, hip and other body parts. They discovered that children who require surgery for hip dysplasia, scoliosis and leg-length discrepancy undergo X-rays or CT scans, and are the children most vulnerable to exposure risk.
Prognosis of Invasive Micropapillary Carcinoma of the Breast Analyzed by Usin...daranisaha
Invasive micropapillary carcinoma (IMPC) is a rare type of breast cancer with high frequency of regional lymph node metastasis. However, the prognosis of IMPC has remained controversial for decades. We aimed to compare the differences of prognosis between IMPC and Invasive ductal carcinoma(IDC) of the breast by utilizing Surveillance, Epidemiology, and End Results (SEER) database.
Prognosis of Invasive Micropapillary Carcinoma of the Breast Analyzed by Usin...eshaasini
Invasive micropapillary carcinoma (IMPC) is a rare type of breast cancer with high frequency of regional lymph node metastasis. However, the prognosis of IMPC has remained controversial for decades. We aimed to compare the differences of prognosis between IMPC and Invasive ductal carcinoma(IDC) of the breast by utilizing Surveillance, Epidemiology, and End Results (SEER) database
Prognosis of Invasive Micropapillary Carcinoma of the Breast Analyzed by Usin...semualkaira
Invasive micropapillary carcinoma (IMPC) is a rare type of breast cancer with high frequency of regional lymph node metastasis. However, the prognosis of IMPC has remained controversial for decades. We aimed to compare the differences of prognosis between IMPC and Invasive ductal carcinoma(IDC) of the breast by utilizing Surveillance, Epidemiology, and End Results (SEER) database.
Prognosis of Invasive Micropapillary Carcinoma of the Breast Analyzed by Usin...semualkaira
Invasive micropapillary carcinoma (IMPC) is a rare type of breast cancer with high frequency of regional lymph node metastasis. However, the prognosis of IMPC has remained controversial for decades. We aimed to compare the differences of prognosis between IMPC and Invasive ductal carcinoma(IDC) of the breast by utilizing Surveillance, Epidemiology, and End Results (SEER) database.
Prognosis of Invasive Micropapillary Carcinoma of the Breast Analyzed by Usin...semualkaira
Invasive micropapillary carcinoma (IMPC) is a rare type of breast cancer with high frequency of regional lymph node metastasis. However, the prognosis of IMPC has remained controversial for decades. We aimed to compare the differences of prognosis between IMPC and Invasive ductal carcinoma(IDC) of the breast by utilizing Surveillance, Epidemiology, and End Results (SEER) database
Safety, risk of complications and the functional feasibility among different kinds of central venous access are still a matter of debate.Not many clinical trials have reported a comparison of complications and patency of CVCs versus Peripherally Inserted Catheters (PICC) as central venous access for indoor patients with advanced gastrointestinal disorder. The aim of the present study was to compare CVCs and PICCs regarding function, complications and convenience in a controlled clinical study on patients aimed for oncology surgery aimed for cure.
Distributions of patients were comparable. Malignant diagnoses were significantly higher among CVC-patients. CVCs and PICCs were used for treatment during equal number of days, without any signifi cant complication rates and with comparable number of days on antibiotics and other potent drugs. The overall cumulative hazard (risk) for treatment interruptions, due to either full-filled clinical indications or due to any complication among the subgroups of patients did not differ.Central Venous Catheter and Peripheral Inserted Central Venous Catheter, for central venous access, did not differ among consecutive unselected patients with serious gastro-intestinal disorders.
Mechanical signals inhibit growth of a grafted tumor in vivo proof of conceptRemy BROSSEL
We apply the principles of physical oncology (or mechanobiology) in vivo to show the effect of a “constraint field” on tumor growth.
http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0152885
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New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
2. Variations in CT scan utilization exist between pediatric and adult
trauma centers. Larson et al. observed an increased CT scan use in chil-
dren who presented to nonpediatric facilities [9]. Similarly, pediatric
trauma patients were twice as likely to undergo a CT scan of the cervical
spine at level I adult trauma centers compared to those who presented
to designated pediatric trauma centers [23]. Finally, children presenting
to a level I trauma center were more likely to receive whole body CT
(WBCT) compared to their adult peers [24].
The aim of this study was to compare the use of WBCT in pediatric
patients among adult and designated pediatric trauma centers by utiliz-
ing the National Trauma Data Bank (NTDB).
1. Materials and methods
We performed a two-year (2011–2012) retrospective analysis using
the NTDB, version 7.3. The NTDB is the largest aggregation trauma registry
data in the United States and contains more than 5 million patient records
contributed by more than 900 trauma centers. It is maintained by the
American College of Surgeons (Chicago, IL). In this study, we included pa-
tients aged less than 18 years, who underwent a head, chest, or abdominal
and pelvic computed tomography, and were managed in a level I or level
II trauma center. The trauma center designation (level I or level II) was de-
termined based on the American College of Surgeons (ACS) list of verified
trauma centers. Patients transferred from other institutions and patients
dead on presentation were excluded from our study.
We abstracted the following data points from the NTDB database:
demographics (age, gender, race, and ethnicity), vitals on presentation
(heart rate, systolic blood pressure, respiratory rate, and temperature),
type of injury (blunt and penetrating), mechanism of injury (motor ve-
hicle collision, falls, pedestrian struck, all-terrain vehicle accidents, stab
wound, gun shout wound), Glasgow Coma Scale (GCS) score on presen-
tation, intoxication details, CT scan utilization details (head, chest, abdo-
men and pelvis), ventilation days, hospital and intensive care unit
length of stay, and in-hospital mortality. Patient's injury characteristics
were abstracted utilizing the Injury Severity Score (ISS) and the Abbre-
viated Injury Scale (AIS) score. Patients were stratified into two groups
based on the center in which they were managed: adult trauma centers
(ATC) or designated pediatric trauma centers (PTC).
Our primary outcome measure was WBCT utilization. CT scan utiliza-
tion was abstracted from the NTDB utilizing the following ICD 9 procedure
codes: head CT (87.03, 87.04), thoracic CT (87.41, 87.42) and abdominal CT
(88.01). Patients with a combination of a head, chest, and abdominal CT
scan were considered to have undergone a WBCT CT scan. WBCT scan
use was compared between ATC and PTC. A subanalysis among adult cen-
ters was performed to compare for performance of WHCT between adult
level I and level II centers. We also compared the head CT, thoracic CT,
and abdominal CT utilization individually between ATC and PTC.
Data are reported as mean ± standard deviation (SD) for continuous
variables, median [range] for ordinal variables, and as proportions for
categorical variables. We performed Mann–Whitney U and student t
test to explore for differences in the two groups (ACT and PTC) for con-
tinuous variables, and chi-square test for categorical variables. Univari-
ate analysis was performed to identify factors predicting WBCT use in
pediatric patients. Factors with a p value ≤0.2 on univariate analysis
were utilized in a multivariate regression analysis. A p value b0.05
was considered statistically significant. All statistical analyses were per-
formed using Statistical Package for Social Sciences (SPSS, Version 21;
IBM, Inc., Armonk, NY).
2. Results
A total of 30,667 patients were included in the study of which, 38.3%
(n = 11,748) were managed in designated pediatric centers. The mean
age was 11.45 ± 6.2 years, 65.5% (n = 20,092) were male, mean systolic
blood pressure was 124.9 ± 20.6 mm of Hg, median GCS was 14 [13–15],
and median injury severity score was 10 [4–12]. The majority (89.8%,
n = 27,541) had blunt injury and motor vehicle crash was the most
common mechanism of injury (44.8%, n = 13,741). Table 1 compares
the demographics and injury characteristics of the ATC and PTC groups.
Patients managed in PTC were younger and more likely to be hypoten-
sive on admission compared to patients managed in ATC. There was no
difference in the admission GCS score, mechanism of injury, severity of
head, thoracic, or abdominal injury and total injury severity score be-
tween patients managed in ATC and PTC.
Table 2 demonstrates the CT scan performance in the study popula-
tion. Head CT scans were performed in 88.3% (n = 27,069) of the patients,
chest CT scans in 33% (n = 10,103), and abdominal CT scans in 49% (n =
15,043) of the patients. A total of 8008 (26.1%) received a WBCT. Patients
managed in ATC were more likely to get a whole body CT scan compared
to patients managed in PTC (p = 0.001). Table 3 demonstrates a
subanalysis of the CT scan performance in level I and level II ATCs. There
was no difference in head CT scan rate however level I adult trauma cen-
ters perform more thoracic and abdominal CT scans.
Table 4 demonstrates the outcomes among the study population.
Mean hospital length of stay was days 3.65 ± 2.5 days and a total of
30.5% (n = 9347) required ICU admission with a mean ICU length of
stay of 1.1 ± 1.2 days. 67.7% (n = 20,763) patients were discharged
home from the hospital. There was no difference in the hospital and
ICU length of stay as well as the discharge disposition among the
Table 1
Patient Characteristic by Group.
Characteristic Adult Center
(n = 18,919)
Pediatric Center
(n = 11,748)
p
Demographics
Age, years (mean ± SD) 12.9 ± 5.8 9.13 ± 6.1 0.01
≤5 years, % 17% 35% 0.01
6–11 years, % 12% 21.4% 0.001
≥12 years, % 71% 43.6% 0.01
Male, % 65.9% 64.9% 0.09
Race
Whites, % 67.3% 67% 0.58
Blacks, % 14.4% 13.9% 0.23
Hispanics, % 15.3% 16% 0.13
Intoxication, % 8.1% 7.6% 0.15
Vital Parameters
GCS, Median [Range] 15 [13–15] 15 [13–15] 0.61
GCS ≤ 8, % 8.3% 7.9% 0.1
ED SBP, (mean ± SD) 127.8 ± 20.5 120.4 ± 19.9 0.8
Hypotensive (SBP ≤ 90), % 3.1% 5.9% 0.001
ED HR, (mean ± SD) 102.1 ± 25.8 109.7 ± 29.3 0.7
Tachycardia (HR N 90), % 50.5% 50.1% 0.96
ED RR, (mean ± SD) 20.16 ± 7.8 22.9 ± 9.1 0.61
ED Temperature, (mean ± SD) 36.1 ± 0.3 36.2 ± 0.1 0.82
Injury Parameters
Blunt 90% 89.5% 0.16
Mechanism of Injury 0.6
MVC, % 45% 44.2% 0.17
Falls, % 17.6% 18% 0.35
Head AIS, Median [IQR] 2 [2–3] 2 [2–3] 0.45
Head AIS ≥ 3, % 34.7% 35.3% 0.28
Thorax AIS, Median [IQR] 1 [1–2] 1 [1–2] 0.71
Thorax AIS ≥ 3, % 18.3% 18.1% 0.65
Abdomen AIS, Median [IQR] 2 [2–3] 2 [2–3] 0.32
Abdomen AIS ≥ 3, % 16.8% 16.4% 0.17
ISS, Median [IQR] 10 [4–13] 9 [4–12] 0.22
ISS ≥ 25, % 9.8% 9.8% 0.79
Table 2
Computed Tomography Scans.
Adult Center
(n = 18,919)
Pediatric Center
(n = 11,748)
p
Whole Body CT Scan, % 31.4% 17.6% 0.001
Head CT Scan, % 88% 88.7% 0.09
Thorax CT Scan, % 39.8% 21.9% 0.01
Abdomen CT Scan, % 53% 42.7% 0.01
2 V. Pandit et al. / Journal of Pediatric Surgery xxx (2015) xxx–xxx
Please cite this article as: Pandit V, et al, The use of whole body computed tomography scans in pediatric trauma patients: Are there differences
among adults and pediatric cen..., J Pediatr Surg (2015), http://dx.doi.org/10.1016/j.jpedsurg.2015.12.002
3. patients in the study population (Fig. 1). The overall mortality rate was
2.1% (n = 663). The mortality rate was similar among patients managed
in adult and pediatric trauma centers (p = 0.37). However patients re-
ceiving WBCT scan had a higher mortality rate compared to patients re-
ceiving selective scanning (3.6% vs. 1.6%, p b 0.001).
2.1. Factors associated with whole body CT scan utilization
Table 5 demonstrates the univariate and multivariate analysis for fac-
tors associated with usage of a whole body CT scan. On univariate analy-
sis, the following factors were linked to WBCT use: age ≥ 6 years, male
gender, intoxication, GCS score ≤ 8, hypotension and tachycardia on pre-
sentation, blunt injury, motor cycle collision, head, thoracic or abdominal
AIS ≥ 3, injury severity score ≥ 25 and management in an ATC. After
adjusting for age, GCS score, admission vital parameters, mechanism,
type and severity of injury, patients who presented in an ATC were 1.8
times more likely (OR: 1.8, CI: 1.3–2.1, p b 0.001) to undergo a WBCT scan.
2.2. Subanalysis for factors associated with usage of whole body CT scan in
patients managed in adult trauma centers: Comparing level 1 vs. level 2
adult centers
On assessing characteristics among patients between level 1 and
level 2 adult centers we found there was no difference in patient's age
Table 3
Computed Tomography Scans, Subanalysis of Adult Center.
Adult Level I
(n = 10,499)
Adult Level II
(n = 8420)
p
Whole Body CT Scan, % 33.2% 29.2% 0.001
Head CT Scan, % 88.6% 87.8% 0.08
Thorax CT Scan, % 41% 38.4% 0.003
Abdomen CT Scan, % 55% 50.4% 0.001
Table 4
Outcomes.
Adult Center
(n = 18,919)
Pediatric Center
(n = 11,748)
p
Hospital LOS, (mean ± SD) 3.62 ± 2.6 3.73 ± 2.3 0.46
ICU LOS, (mean ± SD) 1.1 ± 1.3 1.1 ± 1.2 0.83
Vent Days, (mean ± SD) 0.8 ± 0.4 0.7 ± 0.3 0.71
Discharge Disposition
Home, % 67.4% 68.2% 0.14
Rehabilitation center, % 7.15% 6.8% 0.31
Skilled Nursing Facility, % 0.6% 0.5% 0.25
Mortality, % 2.2% 2.1% 0.37
LOS, length of stay; ICU, intensive care unit; Vent, ventilation.
Fig. 1. Details of the Study Population.
3V. Pandit et al. / Journal of Pediatric Surgery xxx (2015) xxx–xxx
Please cite this article as: Pandit V, et al, The use of whole body computed tomography scans in pediatric trauma patients: Are there differences
among adults and pediatric cen..., J Pediatr Surg (2015), http://dx.doi.org/10.1016/j.jpedsurg.2015.12.002
4. (p = 0.11), gender (p = 0.23), race (p = 0.45), GCS score (p = 0.51),
hypotension (p = 0.31), mechanism of injury (p = 0.67), and severity
of injury (p = 0.14).
On performing univariate analysis, age group 6–11 years (p = 0.03),
intoxication (p = 0.13), GCS score ≤ 8 (p = 0.01), hypotension (p =
0.02), tachycardia (p = 0.04), blunt injury (p = 0.02), head AIS ≥ 3
(p = 0.01), thorax AIS ≥ 3 (p = 0.02), abdomen AIS ≥ 3 (p = 0.02), in-
jury severity score ≥ 25 (p = 0.01), and management in adult level I cen-
ters (p = 0.001) were associated with usage of a whole body CT scan.
After controlling for all factors in a multivariate regression model, man-
agement in adult level I center was independently associated with
usage of a whole body CT scan (p = 0.01). Table 6 demonstrates the uni-
variate and multivariate analysis for subanalysis for factors associated
with use of a whole body CT scan in patients managed only in adult
level 1 and adult level 2 trauma centers.
3. Discussion
Significant differences in CT scan utilization exist between adult and
pediatric trauma centers that treat pediatric patients. Our study showed
that children presenting in adult trauma centers were 1.8 times more
likely to undergo a WBCT, compared to their peers who were treated
in designated pediatric centers, even after adjusting for type and sever-
ity of injury. Specifically relative head CT rates did not differ among pe-
diatric and adult trauma centers, thoracic and abdominal CT rates were
significantly higher in adult trauma centers.
Understating the causes for this variability in management and es-
tablishing protocols for minimizing the use of WBCT across centers
will standardize care.
In our study we found that WBCT scan utilization is different among
trauma centers with different levels and particularly different referred
population. Similarly, differences in imaging utilization among PTCs
and ATCs have been described in several other studies. Mannix et al. ob-
served more frequent utilization of cervical spine CT scans in children
presenting at level I adult trauma centers compared to those being eval-
uated in pediatric trauma centers, as well as an increase in CT scan rates
over their study period by non pediatric centers [23]. Similarly, the lib-
eral use of CT scans in the ED facilities has been mainly adopted by
nonpediatric centers [9]. Several factors may contribute to those ob-
served differences. Most importantly, adult centers may lack pediatric
CT protocols that adjust for patients' characteristics and limit radiation
exposure [18]. Additionally, nondesignated pediatric centers may
apply adult guidelines to presenting pediatric patients and may not be
familiar with different patterns of injury in children. Strength of our
study is that as a result of adjusting for confounding factors in analysis,
we had similar cohort of patients to compare. Subsequently we found
that the likelihood of performing a WBCT in ATC was higher, indepen-
dent of injury severity or pattern.
WBCT scan is advocated owing to survival benefit in adult trauma cen-
ters [20–22,25,26]. Caputo et al. in a metaanalysis showed that patients
undergoing a WBCT, despite having significantly higher ISS at baseline
compared with the group who received selective scanning, had a lower
overall mortality rate and a more favorable pooled odds ratio [22]. How-
ever there is a lack of knowledge regarding the utility of WBCT in pediatric
population and its relation to outcomes. In our study we could not find a
survival advantage between PTC and ATC, However patients undergoing a
WBCT compared to selective scanning had a higher mortality rate overall.
This may be because of selective approach to only perform a WBCT scan in
severely injured pediatric trauma patients.
Several authors have examined the use of alternative imaging mo-
dalities such as x-rays or ultrasound for identification of injuries
[16,27,17,28,29]. Although FAST has been proposed as an adjunct for
the evaluation of a pediatric trauma patient by the ACS, its clinical use-
fulness remains debated [28,29]. Furthermore, chest x-rays should serve
as the initial imaging modality in pediatric blunt trauma patients,
with thoracic CT only to be used in certain circumstances [16,30]. The
selective use of tube thoracostomy for the treatment of occult
pneumothoraces further supports those findings [12]. In addition, x-
ray is a reliable imaging study for identification of bone and soft tissue
injuries [27].
We found that CT scan rates of the chest and abdomen were signifi-
cantly higher in adult trauma centers. This finding is particularly impor-
tant as a possible association with increased survival can alleviate the
importance of perceived negative effect from excess radiation. In an ef-
fort to limit the CT use in pediatric trauma patients, several guidelines
and prediction models for clinically important injuries have been devel-
oped that recommend selective imaging based on mechanism of injury,
physical examination and laboratory data [13–15,19,31,32]. Holmes
et al. created a prediction rule based solely on history and physical ex-
amination that would rule out a clinically significant abdominal injury
Table 5
Factors Associated with Need for Whole Body CT Scan.
Univariate OR
(95% CI)
p Multivariate OR
(95% CI)
p
Adult Center 2.1 (1.5–3.6) 0.001 1.8 (1.3–2.1) 0.001
Demographics
Age
6–11 years 1.2 (1.1–4.1) 0.02 1.1 (0.91–3.4) 0.12
≥12 years 1.1 (1.05–2.3) 0.04 1.1 (0.79–2.9) 0.19
Male 1.2 (0.71–3.8) 0.18 1.1 (0.64–4.2) 0.41
Whites 1.3 (0.51–5.6) 0.36 – –
Hispanics 1.1 (0.76–3.2) 0.41 – –
Intoxication 1.5 (1.1–4.4) 0.04 1.4 (0.91–4.6) 0.11
Vital Parameters
GCS score ≤ 8 1.9 (1.4–6.2) 0.02 1.3 (1.2–3.9) 0.04
Hypotension (SBP ≤ 90) 1.4 (1.2–3.5) 0.03 1.2 (1.1–2.6) 0.04
Tachycardia (HR ≥ 100) 1.6 (1.1–4.7) 0.04 1.4 (0.94–3.1) 0.15
Respiratory Rate 1.3 (0.75–2.3) 0.51 – –
Temperature 1.1 (0.39–3.7) 0.66 – –
Injury Parameters
Blunt Injury 1.4 (1.2–2.9) 0.03 1.2 (0.98–2.3) 0.09
Mechanism of Injury
MVC 1.4 (1.1–5.1) 0.04 1.1 (0.82–3.1) 0.2
Falls 1.1 (0.72–5.9) 0.61 – –
Head AIS ≥ 3 1.3 (1.1–6.2) 0.02 1.2 (1.1–5.4) 0.04
Thorax AIS ≥ 3 1.8 (1.4–9.6) 0.04 1.5 (0.94–8.2) 0.09
Abdomen AIS ≥ 3 1.4 (1.2–4.7) 0.03 1.2 (1.1–3.1) 0.04
ISS ≥ 25 2.6 (1.5–4.4) 0.01 2.1 (1.3–5.8) 0.02
Table 6
Subanalysis of Patients Managed in Adult Centers.
Univariate OR
(95% CI)
p Multivariate OR
(95% CI)
p
Adult Level I Center 1.9 (1.2–3.1) 0.001 1.3 (1.1–2.8) 0.01
Demographics
Age
6–11 years 1.4 (1.1–3.5) 0.03 1.2 (0.98–2.9) 0.09
≥12 years 1.2 (0.81–2.1) 0.3 – –
Male 1.1 (0.84–4.2) 0.41 – –
Whites 1.3 (0.65–7.4) 0.62 – –
Hispanics 1.2 (0.88–5.4) 0.39 – –
Intoxication 1.4 (0.96–4.9) 0.13 1.2 (0.84–3.4) 0.24
Vital Parameters
GCS Score ≤ 8 1.5 (1.2–6.9) 0.01 1.2 (1.1–5.5) 0.03
Hypotension (SBP ≤ 90) 1.6 (1.4–5.8) 0.02 1.1 (1.05–4.2) 0.04
Tachycardia (HR ≥ 100) 1.4 (1.2–3.4) 0.04 1.2 (0.98–2.7) 0.12
Respiratory Rate 1.1 (0.62–2.9) 0.59 – –
Temperature 1.2 (0.55–2.3) 0.35 – –
Injury Parameters
Blunt Injury 1.5 (1.1–2.5) 0.02 1.1 (0.84–1.9) 0.13
Mechanism of Injury
MVC 1.3 (0.91–4.5) 0.31 – –
Falls 1.2 (0.69–3.2) 0.46 – –
Head AIS ≥ 3 1.6 (1.4–8.4) 0.01 1.4 (1.2–9.5) 0.03
Thorax AIS ≥ 3 1.4 (1.1–7.4) 0.02 1.1 (1.06–10.3) 0.04
Abdomen AIS ≥ 3 1.5 (1.1–3.9) 0.02 1.2 (1.1–4.5) 0.04
ISS ≥ 25 2.1 (1.8–6.4) 0.01 1.8 (1.4–7.2) 0.01
4 V. Pandit et al. / Journal of Pediatric Surgery xxx (2015) xxx–xxx
Please cite this article as: Pandit V, et al, The use of whole body computed tomography scans in pediatric trauma patients: Are there differences
among adults and pediatric cen..., J Pediatr Surg (2015), http://dx.doi.org/10.1016/j.jpedsurg.2015.12.002
5. that would require surgical intervention, embolization or blood transfu-
sion [19]. Further studies have added abnormal laboratory data such as
hematuria and increased liver function tests to their models that would
predict blunt abdominal trauma [15,31]. However, in our study we
found no difference in survival between ATC and PTC in management of
pediatric patients. Similarly, Jindal et al. reported higher rates of WBCT
use in pediatric patients presenting with mild to moderate trauma com-
pared to their adult peers, without any difference in outcomes [24].
The reported rise in CT scan use in the pediatric population has
prompted several authors to emphasize the significant radiation exposure
and malignancy risk associated with its use [2,3,5,6]. Egan et al. noted an
important breast radiation exposure in female trauma patients who
underwent thoracic CT for spine clearance, a radiation risk that was sub-
stantially higher in children compared to adolescents [7]. Additionally, pe-
diatric trauma patients receiving more than two CT scans, including WBCT
scans, are being exposed to significantly higher radiation compared to
those undergoing less imaging [4]. Although we do not have data regard-
ing the amount of radiation exposure in PTC compared to ATC, our data
support reduction in use of CT scans in adult trauma centers as no survival
benefit is observed in an adjusted analysis from a national database.
In our study we defined pediatric patients with age ≤ 18 years as this
is the most widely used definition across multiple studies to define pe-
diatric patients. Furthermore, majority of the institutions reporting to
the NTDB have defined pediatric patients as age ≤ 18 years. We under-
stand that there remain variations across institutions for defining the
age cutoff for pediatric patients however; as the NTDB does not provide
institutional identifiers, we were not able to assess the age cutoff in each
institution which is a potential limitation of the database.
Ourstudyhas certainlimitations.AlthoughtheNTDB representsthelarg-
est trauma registry, our results maynot begeneralizablegiventhe retrospec-
tive nature of the database and missing data. Additionally, we were not able
to detect CT scan rates of the cervical spine as they currently lack an ICD 9
procedure code. Moreover, the clinical significance of the CT scan utilization
could not becaptured inthis study, i.e. we were not ableto examine how the
presence of the CT scan served as a guide for further management. We were
unable to assess the pediatric training of providers managing patients across
centers. We did not assess the causes for mortality in our patient population.
Despite these limitations, our study presents the largest study that examines
the WBCT utilization among pediatric and adult trauma centers.
4. Conclusion
Variability exists in the use of WBCT scan across trauma centers with
no difference in patient outcomes. Pediatric patients who underwent a
CT were more likely to be managed with WBCT in adult trauma centers
were, increasing their risk for radiation without a difference in out-
comes. Establishing protocols for minimizing the use of WBCT in pediat-
ric population across adult trauma centers may standardize trauma care
for the pediatric trauma patient.
Acknowledgements
No acknowledgements to make.
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Please cite this article as: Pandit V, et al, The use of whole body computed tomography scans in pediatric trauma patients: Are there differences
among adults and pediatric cen..., J Pediatr Surg (2015), http://dx.doi.org/10.1016/j.jpedsurg.2015.12.002