Head Computed Tomography Scanning During Pediatric

Authors: Kerri L LaRovere Molly S Brett Robert C Tasker Keith J Strauss Jeffrey P Burns The Pediatric Critical Nervous System Program pCNSp

Publish Date: 2011/09/21

Volume: 16, Issue: 2, Pages: 251-257

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Abstract

204 PICU patients underwent head CT during 2008–2009 Therapeutic interventions and resource intensity during CT were categorized Severity of illness was summarized using the pediatric risk of mortality PRISMIII model Estimates of patient radiation dose were based on dose measurements made in four anthropomorphic head phantoms242 62 out of 391 head CT studies were portable New pathology was identified on 80 40 scans CT findings prompted a change in management in 46 23 patients 25 of these resulted in lifeextending treatments and 21 had forgoing of lifesustaining treatments within 24 hours 26 patients with PRISM score greater than 30 underwent CT 23 88 of these were portable More portable versus fixed examinations were performed in patients requiring extracorporeal membrane oxygenation inhaled nitric oxide high levels of positive end expiratory pressure and those with high vasopressor scores P  005 Estimated patient dose from portable CT was 83 ± 6 mGy compared to 72 + 5 mGy for patients imaged on a fixed scanner P  00001Twothirds of CT scans obtained in the PICU were portable because of patients’ intensity of therapy and illness severity Portable CT showed major new pathology in greater than 1/3 and led to a change in management in 1/4 of higher acuity patients scanned The estimated radiation dose from portable CT is within the current national guidelinesThe authors would like to thank all staff at Children’s Hospital Boston who participated in the care of these patients The Pediatric Critical Nervous System Program pCNSp is comprised of the Neurocritical Care ICU service the Critical Care Neurology consult service the neurosurgical service and neuroradiology The authors also thank Matthew Gregas for statistical support Patricia Berry Charles Hornberger and Peter Betit for database support and Alison Clapp for librarian support This research was funded by the Department of Anesthesia at Children’s Hospital BostonNeurocritical Care ICU service From the Division of Critical Care Medicine Jeffrey Burns Chief Division of Critical Care Medicine John Arnold Monica Kleinman Robert Graham Daniel Kohane Thomas Mancuso Michael McManus Nilesh Mehta Robert Pascucci Gregory Priebe Adrienne Randolph Robert Truog Meredith van der Velden Sally Vitali Peter Weinstock Gerhard Wolf Christopher Weldon From the division of Cardiovascular Critical Care Peter Laussen Chief Division of Cardiovascular Intensive Care Melvin Almodovar Ravi Thiagarajan James DiNardo Thomas Kulik Joshua Salvin Cindy Barrett Sarah Teele Catherine Allan John Kheir Vamsi Yarlagadda Satish Rajagopal

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