A Portable CT Scanner in the Pediatric Intensive Care Unit Decreases Transfer-Associated Adverse Events and Staff Disruption
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Computerized tomography (CT) is an important diagnostic tool in the management of critically ill children, especially those with neurosurgical problems such as traumatic brain injury. Traditionally, such scans require transfer to the radiology department (RD) at times of extreme physiological instability, such as incipient cerebral herniation, and exposes children with actual, or potential, spinal injuries to the risks of transfer. Moving children from pediatric intensive care (PIC), often overnight, also depletes units of senior staff. Portable CT (PCT) scanning offers a solution to this problem, and we assessed patient stability and staff time occupied during urgent CT scans before and after the introduction of a PCT scanner (CereTom®) in a regional neurosurgical pediatric intensive care unit (PICU).
Materials and Methods:
Prospective observational study of ventilated children in the PICU requiring urgent CT of the head to limit secondary brain injury. Data was collected for three months prior to, and for the same period after, the introduction of PCT on a questionnaire designed to assess physiological variables, PICU interventions, and staff time, which was completed immediately post scanning.
Eight children had urgent CT head scan in the RD during the first 3 months and ten PCT in the second 6 months. The patients transferred to the RD required medical intervention because of cardio-respiratory instability or fluctuating intracranial pressure in nearly every patient and clearly increased the strain on staff resources. None of those patients undergoing PCT had untoward events and staff resources were far less impacted upon.
PCT scanning is safe for unstable neurosurgical patients who need urgent diagnostic head CT, reducing the risks associated with transfer and the depletion of staff provision to the other children in the PICU. While this study did not specifically address image quality, all images were diagnostic regarding the indication for scanning.
Key WordsPediatrics Trauma Head injury Neurosurgery Portable CT imaging
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- 9.Marmarou A, Anderson RL, Ward JD, Choi SC, Young HF, Eisenberg HM, Foulkes MA, Marshall LF, Jane JA. Impact of ICP instability and hypotension on outcome in patients with severe head trauma. J Neurosurg 1991;75:S59–66.Google Scholar
- 13.Hertzog JH, Cartie RJ, Hauser GJ, Dalton HJ, Cleary K. The use of a mobile computed tomography scanner in the pediatric intensive care unit to evaluate airway stenting and lung volumes with varying levels of positive end-expiratory pressure. Pediatr Crit Care Med 2001;2:346–8.CrossRefPubMedGoogle Scholar
- 15.Gunnarsson T, Theodorsson A, Karlsson P, Fridriksson S, Boström S, Persliden J, Johansson I, Hillman J. Mobile computerized tomography scanning in the neurosurgery intensive care unit: increase in patient safety and reduction of staff workload. J Neurosurg 2000;93:432–36.CrossRefPubMedGoogle Scholar