Objectives There is a clear dose-response relationship between radiation dose in childhood and increased risk of cancer.¹Computerised Tomography (CT) imaging is a significant radiation exposure for children, and as such radiation should be selective and minimised to that which is ‘As Low As Reasonably Achievable’ (ALARA). National guidance supports clinicians in the rationalisation of imaging strategies for paediatric trauma patients. A recent analysis suggests that improvements in the appropriateness of imaging choice nationally have not been sustained.2–4 Regionally following an audit assessing compliance with national guidelines over five years from 2014 to 2019, an education programme (which included regional teaching and local resources) was established to improve imaging appropriateness in the region. This re-audit aimed to describe compliance with national guidance following the introduction of educational interventions.

Methods A retrospective review of all paediatric trauma patients(<16yrs) with an Injury Severity Score (ISS) >8, admitted to the regional Major Trauma Centre between December 2020 and January 2022 was undertaken. Details of all imaging were identified and admitting history and documentation reviewed to establish the appropriateness of imaging in line with national guidance published by NICE in 2016, (which has been informed by the Royal College of Radiologist UK Paediatric Trauma Protocols).^{2 3} Data are reported as number (percentage). The study was registered locally as a clinical audit and ethical approval was not required.

Results Over the two-year period, 129/168 (76.7%) of patients had CT scans. Of these patients 22/124 (17.7%) of these had clinically unjustified scans compared to 116/632 (18.4%) overall in the previous audit. However, in the final year of the previous audit 22/65 (34%) of patients were affected. The trends are shown in figure 1.

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Abstract 6625 Figure 1

% of patients affected by clinically unjustified scans by year

The greatest proportion (14/35 (40%), shown in figure 2) of inappropriate CTs were of the chest, which is consistent with the previous audit (76/116 (65.5%)).

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Abstract 6625 Figure 2

Unjustified CT scans by body area

Conclusion In contrast to national trends, this re-audit demonstrated a sustained reduction in clinically inappropriate imaging following the educational interventions. Continued dissemination of guidance and on-going education is required to sustain adherence to national guidance. These results emphasise an ongoing need to audit and educate professionals involved in the acute care of children with major trauma.

References

1. Kutanzi KR, Lumen A, Koturbash I, Miousse IR. Pediatric exposures to ionizing radiation: carcinogenic considerations. Int J Environ Res Public Health. 2016;13(11):1057.

2. National Institute for Health and Care Excellence. Major trauma: assessment and initial management. NICE Guideline [NG39]. 2019. https://www.nice.org.uk/guidance/ng39 [Accessed 03/08/23].

3. The Royal College of Radiologists. Paediatric trauma protocols. The Royal College of Radiologists; 2014. https://www.rcr.ac.uk/publication/paediatric-trauma-protocols [Accessed 03/08/23].

4. Negus S, Bouamra O, Roland D. Have the UK pediatric trauma protocols resulted in a reduction in chest computed tomography imaging for children presenting with major blunt trauma? J Am Coll Emerg Physicians Open. 2023;4(5):e13041.