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Is Whole-Body CT Associated With Reduced In-Hospital Mortality in Children With Trauma? A Nationwide Study*

Abe, Toshikazu, MD, MPH1,2; Aoki, Makoto, MD, PhD3; Deshpande, Gautam, MD1; Sugiyama, Takehiro, MD, MSHS, PhD2,4; Iwagami, Masao, MD, MSc, PhD2; Uchida, Masatoshi, MD2; Nagata, Isao, MD, MPH2; Saitoh, Daizoh, MD, PhD5; Tamiya, Nanako, MD, MS, PhD2

Pediatric Critical Care Medicine: June 2019 - Volume 20 - Issue 6 - p e245–e250
doi: 10.1097/PCC.0000000000001898
Online Clinical Investigations
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Objectives: We aimed to investigate whether whole-body CT for children with trauma is associated with a different mortality than only selective CT.

Design: A multicenter, retrospective cohort study.

Setting: Nationwide trauma registry from 183 tertiary emergency medical centers in Japan.

Patients: We enrolled pediatric trauma patients less than 16 years old who underwent whole-body CT or selective CT from 2004 to 2014.

Interventions: We classified the patients into a whole-body CT group if they underwent head, chest, abdomen, and pelvis CT and a selective CT group if they underwent at least one, but not all, of the above scans.

Measurements and Main Results: We analyzed data from 9,170 eligible patients (males, 6,362 [69%]; median age, 9 yr [6–12 yr]). Of these, 3,501 (38%) underwent whole-body CT. The overall in-hospital mortality was 180 of 9,170 (2.0%), that of patients who underwent whole-body CT was 102 of 3,501 (2.9%), and that of patients who underwent selective CT was 78 of 5,669 (1.4%). After adjusted multilevel logistic regressions and propensity score matching, the whole-body CT group demonstrated no significant difference in terms of in-hospital mortality compared with the selective CT group. The adjusted odds ratios (whole-body CT vs selective CT) for in-hospital mortality were as follows: multilevel logistic regression model 1 (1.05 [95% CI, 0.70–1.56]); multilevel logistic regression model 2 (0.72 [95% CI, 0.44–1.17]); propensity score-matched model 1 (0.98 [95% CI, 0.65–1.47]); and propensity score-matched model 2 (0.71 [95% CI, 0.46–1.08]). Subgroup analyses also revealed similarities between CT selection and in-hospital mortality.

Conclusions: In this nationwide study, whole-body CT was frequently used among Japanese children with trauma. However, compared with the use of selective CT, our results did not support the use of whole-body CT to reduce in-hospital mortality. Selective use of imaging may result in less radiation exposure and provide more benefits than whole-body CT to pediatric trauma patients.

1Department of General Medicine, Juntendo University, Tokyo, Japan.

2Department of Health Services Research, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan.

3Department of Emergency Medicine, Gunma University Graduate School of Medicine, Maebashi, Japan.

4Diabetes and Metabolism Information Center, Research Institute, National Center for Global Health and Medicine, Tokyo, Japan.

5Department of Traumatology and Emergency Medicine, National Defense Medical College, Tokorozawa, Japan.

*See also p. 579.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s website (http://journals.lww.com/pccmjournal).

Supported, in part, by JSPS KAKENHI (Grant Number JP 16K15388).

Dr. Deshpande received funding from Daiichi Sankyo (speaker fee). The remaining authors have disclosed that they do not have any potential conflicts of interest.

Ethical approval: The Medical Ethics Committee of the Gunma University Hospital, which does not require consent from patients for observational studies using anonymous data, approved this study. The Ethics Committee at Juntendo University Urayasu Hospital also approved the use of the Japan Trauma Data Bank (JTDB) data. The JTDB administrators also approved the permission to use the data.

For information regarding this article, E-mail: abetoshi111@gmail.com

©2019The Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies