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Pediatric solid organ injury – frequency of abdominal imaging is determined by the treating department

To investigate the use of abdominal CT scanning in the management of pediatric blunt abdominal trauma in pediatric and non-pediatric departments. In this observational cohort study, anonymized data were extracted from 2 large German statutory health insurances (∼5.9 million clients) in a 7-year peri...

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Autores principales: Zimmermann, Peter, Schmidt, Torben, Nelson, Jana, Gosemann, Jan-Hendrik, Bassler, Stefan, Stahmeyer, Jona T., Hirsch, Franz Wolfgang, Lacher, Martin, Zeidler, Jan
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Lippincott Williams & Wilkins 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7647522/
https://www.ncbi.nlm.nih.gov/pubmed/33157961
http://dx.doi.org/10.1097/MD.0000000000023057
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author Zimmermann, Peter
Schmidt, Torben
Nelson, Jana
Gosemann, Jan-Hendrik
Bassler, Stefan
Stahmeyer, Jona T.
Hirsch, Franz Wolfgang
Lacher, Martin
Zeidler, Jan
author_facet Zimmermann, Peter
Schmidt, Torben
Nelson, Jana
Gosemann, Jan-Hendrik
Bassler, Stefan
Stahmeyer, Jona T.
Hirsch, Franz Wolfgang
Lacher, Martin
Zeidler, Jan
author_sort Zimmermann, Peter
collection PubMed
description To investigate the use of abdominal CT scanning in the management of pediatric blunt abdominal trauma in pediatric and non-pediatric departments. In this observational cohort study, anonymized data were extracted from 2 large German statutory health insurances (∼5.9 million clients) in a 7-year period (2010–2016). All patients with inpatient International Classification of Diseases (ICD) codes S36.- and S37.- (injury of intra-abdominal organs; injury of urinary and pelvic organs) aged ≤18 years were included. Demographic and clinical data were analyzed by logistic regression analysis for associations with the use of abdominal CT. A total of 524 children with blunt abdominal trauma (mean age 11.0 ± 5.2 years; 62.6% males) were included; 164 patients (31.3%) received abdominal CT-imaging. There were no significant differences in traumatic non-intraabdominal comorbidity patterns (injuries of external causes; injuries to the head or thorax). There was substantial variability in the rate of abdominal CT imaging among different medical disciplines ranging from 11.6% to 44.5%. Patients admitted to pediatric departments (Pediatrics and Pediatric Surgery) underwent abdominal CT imaging significantly less frequently (19.7%; N = 55) compared to patients treated in non-pediatric departments (General/Trauma Surgery: 44.5%; N = 109) irrespective of concomitant injuries. The estimated OR for the use of abdominal CT by General/Trauma Surgery was 6.2-fold higher (OR: 6.15 [95-%-CI:3.07–13.21]; P < .001) compared to Pediatric Surgery. Other risk factors associated with the use of abdominal CT were traumatic extra-abdominal comorbidities, increasing age, male gender, and admission to a university hospital. Abdominal CT imaging was significantly less frequently used in pediatric departments. The substantial variability of the abdominal CT rate among different medical disciplines and centers indicates a potential for reduction of CT imaging by implementation of evidence-based guidelines. Furthermore, our study underlines the need for centralization of pediatric trauma care in Germany not only to improve patient outcome but to avoid radiation-induced cancer mortality.
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spelling pubmed-76475222020-11-09 Pediatric solid organ injury – frequency of abdominal imaging is determined by the treating department Zimmermann, Peter Schmidt, Torben Nelson, Jana Gosemann, Jan-Hendrik Bassler, Stefan Stahmeyer, Jona T. Hirsch, Franz Wolfgang Lacher, Martin Zeidler, Jan Medicine (Baltimore) 7100 To investigate the use of abdominal CT scanning in the management of pediatric blunt abdominal trauma in pediatric and non-pediatric departments. In this observational cohort study, anonymized data were extracted from 2 large German statutory health insurances (∼5.9 million clients) in a 7-year period (2010–2016). All patients with inpatient International Classification of Diseases (ICD) codes S36.- and S37.- (injury of intra-abdominal organs; injury of urinary and pelvic organs) aged ≤18 years were included. Demographic and clinical data were analyzed by logistic regression analysis for associations with the use of abdominal CT. A total of 524 children with blunt abdominal trauma (mean age 11.0 ± 5.2 years; 62.6% males) were included; 164 patients (31.3%) received abdominal CT-imaging. There were no significant differences in traumatic non-intraabdominal comorbidity patterns (injuries of external causes; injuries to the head or thorax). There was substantial variability in the rate of abdominal CT imaging among different medical disciplines ranging from 11.6% to 44.5%. Patients admitted to pediatric departments (Pediatrics and Pediatric Surgery) underwent abdominal CT imaging significantly less frequently (19.7%; N = 55) compared to patients treated in non-pediatric departments (General/Trauma Surgery: 44.5%; N = 109) irrespective of concomitant injuries. The estimated OR for the use of abdominal CT by General/Trauma Surgery was 6.2-fold higher (OR: 6.15 [95-%-CI:3.07–13.21]; P < .001) compared to Pediatric Surgery. Other risk factors associated with the use of abdominal CT were traumatic extra-abdominal comorbidities, increasing age, male gender, and admission to a university hospital. Abdominal CT imaging was significantly less frequently used in pediatric departments. The substantial variability of the abdominal CT rate among different medical disciplines and centers indicates a potential for reduction of CT imaging by implementation of evidence-based guidelines. Furthermore, our study underlines the need for centralization of pediatric trauma care in Germany not only to improve patient outcome but to avoid radiation-induced cancer mortality. Lippincott Williams & Wilkins 2020-11-06 /pmc/articles/PMC7647522/ /pubmed/33157961 http://dx.doi.org/10.1097/MD.0000000000023057 Text en Copyright © 2020 the Author(s). Published by Wolters Kluwer Health, Inc. http://creativecommons.org/licenses/by-nc/4.0 This is an open access article distributed under the terms of the Creative Commons Attribution-Non Commercial License 4.0 (CCBY-NC), where it is permissible to download, share, remix, transform, and buildup the work provided it is properly cited. The work cannot be used commercially without permission from the journal. http://creativecommons.org/licenses/by-nc/4.0
spellingShingle 7100
Zimmermann, Peter
Schmidt, Torben
Nelson, Jana
Gosemann, Jan-Hendrik
Bassler, Stefan
Stahmeyer, Jona T.
Hirsch, Franz Wolfgang
Lacher, Martin
Zeidler, Jan
Pediatric solid organ injury – frequency of abdominal imaging is determined by the treating department
title Pediatric solid organ injury – frequency of abdominal imaging is determined by the treating department
title_full Pediatric solid organ injury – frequency of abdominal imaging is determined by the treating department
title_fullStr Pediatric solid organ injury – frequency of abdominal imaging is determined by the treating department
title_full_unstemmed Pediatric solid organ injury – frequency of abdominal imaging is determined by the treating department
title_short Pediatric solid organ injury – frequency of abdominal imaging is determined by the treating department
title_sort pediatric solid organ injury – frequency of abdominal imaging is determined by the treating department
topic 7100
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7647522/
https://www.ncbi.nlm.nih.gov/pubmed/33157961
http://dx.doi.org/10.1097/MD.0000000000023057
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