Abstract

Background

Demand for pediatric cardiac computed tomography (CT) angiography is increasing due to recent advances that reduce the need for sedation and radiation exposure while enhancing diagnostic accuracy. This has resulted in the increasing use of cardiac CT angiography emergently during weekends and after hours. The unexpected demand for these services can be challenging, as most hospitals are not staffed to provide 24/7 pediatric cardiovascular imaging.

Objective

To describe a large single-center experience of providing emergent cardiac CT angiography services in children.

Materials and methods

We identified all patients who underwent after-­hours weekday and weekend emergent cardiac CT angiography between January 2017 and August 2018. Cardiac CT angiography in the settings of congenital heart disease and coronary imaging were included. Data collected included day and time of cardiac CT angiography, patient age, referral unit, indication, surgical history, need for sedation, need for surgery, intervention and/or change in medical management based on the cardiac CT angiography.

Results

Forty-seven studies were identified, 26 (55%) of which were performed on a weekend or holiday and 21 (45%) after 5 p.m. on a weekday. Based on cardiac CT angiography findings, 20 (43%) patients underwent either surgery or an interventional procedure, and 9 (19%) had a change in medical management. The time between cardiac CT angiography and the related surgery/intervention ranged from 0 to 29 days with a median of 3.5 days.

Conclusion

Emergent pediatric cardiac CT angiography is a valuable service. Larger multi-institutional studies with standardized referral and utilization patterns are needed to determine if outcomes are affected by this service, which in turn will influence hospital staffing patterns for emergent imaging.

中文翻译：

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急诊儿科心脏计算机断层血管造影服务的价值：在大型儿童医院的初步经验。

摘要

背景

由于最近的进展减少了对镇静和辐射​​暴露的需求，同时又提高了诊断的准确性，因此对小儿心脏计算机断层扫描（CT）血管造影的需求正在增加。这导致在周末和几小时后紧急增加心脏CT血管造影的使用。对这些服务的意外需求可能是具有挑战性的，因为大多数医院都没有人员提供24/7小儿心血管成像。

目的

描述为儿童提供紧急心脏CT血管造影服务的大型单中心经验。

材料和方法

我们确定了2017年1月至2018年8月之间在工作日和周末下班后进行的所有患者的紧急CT血管造影检查。包括先天性心脏病和冠状动脉成像的心脏CT血管造影检查。收集的数据包括心脏CT血管造影术的日期和时间，患者年龄，转诊单位，适应症，手术史，镇静需要，手术需要，干预和/或基于心脏CT血管造影术的医疗管理变化。

结果

鉴定出47项研究，其中26项（55％）在周末或假日进行，而21项（45％）在工作日的下午5点进行。根据心脏CT血管造影的发现，有20例（43％）接受了手术或介入手术，而9例（19％）的医疗管理发生了变化。心脏CT血管造影与相关手术/干预之间的时间为0到29天，中位数为3.5天。

结论

紧急儿科心脏CT血管造影是一项有价值的服务。需要使用标准的转诊和使用模式进行大型的多机构研究，以确定结果是否受到这项服务的影响，而这反过来又会影响医院急诊影像的人员配置模式。