Objective

Intra-abdominal injury occurs in less than 15% of pediatric trauma activations but can be life-threatening. Computed tomography (CT) imaging is commonly ordered in pediatric trauma, even when intra-abdominal injury risk is low. We aimed to reduce abdominal/pelvic CT rates in children at very low risk for intra-abdominal injury requiring trauma activation at our pediatric trauma centre.

Methods

We implemented a quality improvement initiative using the Model for Improvement in children 0–15.99 years of age who activated a trauma response and were evaluated for intra-abdominal injury. Interventions included clinical decision support, institutional education, and individual audit and feedback. Our primary outcome was abdominal/pelvic CT rate in patients at very low risk for intra-abdominal injury. Balancing measures included CT scans ordered within 24 h of emergency department (ED) assessment and return to ED or hospitalization within 72 h for missed intra-abdominal injury. Statistical process control was used to evaluate rates over time.

Results

The baseline period (April 1, 2016 – November 30, 2017) included 359 trauma patients with a CT rate of 26.8% (95% CI 20.5–33.8%) in those at low risk for intra-abdominal injury. The intervention period (Dec 1, 2017–Dec 31, 2019) included 445 patients with a CT rate in low-risk patients of 6.8% (95% CI 3.2–12.6%), demonstrating an absolute reduction of 20.0% (95% CI 12.2–27.7%, p < 0.05). Interventions resulted in a significant decrease in abdominal/pelvic CT imaging corresponding with special cause variation. No clinically significant intra-abdominal injuries were missed.

Conclusions

This quality improvement initiative reduced abdominal/pelvic CT rates in pediatric trauma patients at low risk for intra-abdominal injury without any missed cases of significant injury. Leveraging standardized decision tools to reduce unnecessary CT imaging can be successfully accomplished without compromising care.

中文翻译：

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安全地减少儿科创伤中的腹部/盆腔计算机断层扫描成像：一项质量改进计划

客观的

不到 15% 的儿科创伤激活会发生腹内损伤，但可能会危及生命。计算机断层扫描 (CT) 成像通常用于儿科创伤，即使腹内损伤风险较低。我们的目标是降低在我们的儿科创伤中心需要进行创伤激活的腹内损伤风险极低的儿童的腹部/盆腔 CT 率。

方法

我们使用改进模型对 0-15.99 岁的儿童实施了一项质量改进计划，这些儿童激活了创伤反应并接受了腹内损伤评估。干预措施包括临床决策支持、机构教育以及个人审计和反馈。我们的主要结局是腹腔内损伤风险极低的患者的腹部/盆腔 CT 率。平衡措施包括在急诊科 (ED) 评估后 24 小时内下令进行 CT 扫描，并在 72 小时内返回急诊科或因错过腹内损伤而住院。统计过程控制用于评估随时间变化的速率。

结果

基线期（2016 年 4 月 1 日至 2017 年 11 月 30 日）包括 359 名创伤患者，其 CT 率为 26.8%（95% CI 20.5-33.8%）的低风险腹内损伤患者。干预期（2017 年 12 月 1 日至 2019 年 12 月 31 日）包括 445 名患者，低风险患者的 CT 率为 6.8%（95% CI 3.2-12.6%），显示绝对减少 20.0%（95% CI 12.2–27.7%，p  < 0.05）。干预措施导致腹部/盆腔 CT 成像显着减少，这与特殊原因变异相对应。没有遗漏临床上显着的腹内损伤。

结论

这项质量改进举措降低了腹腔内损伤风险低的儿科创伤患者的腹部/盆腔 CT 率，而没有任何严重损伤的遗漏病例。利用标准化决策工具减少不必要的 CT 成像可以在不影响护理的情况下成功完成。