Neurocritical Care

, Volume 16, Issue 2, pp 251–257 | Cite as

Head Computed Tomography Scanning During Pediatric Neurocritical Care: Diagnostic Yield and the Utility of Portable Studies

  • Kerri L. LaRovere
  • Molly S. Brett
  • Robert C. Tasker
  • Keith J. Strauss
  • Jeffrey P. Burns
  • The Pediatric Critical Nervous System Program (pCNSp)
Original Article

Abstract

Background

We report our use of portable head computed tomography (CT) and the diagnostic yield and radiation dose from head CT in the pediatric intensive care unit (PICU).

Methods

204 PICU patients underwent head CT during 2008–2009. Therapeutic interventions and resource intensity during CT were categorized. Severity of illness was summarized using the pediatric risk of mortality (PRISM-III) model. Estimates of patient radiation dose were based on dose measurements made in four anthropomorphic head phantoms.

Results

242 (62%) out of 391 head CT studies were portable. New pathology was identified on 80 (40%) scans. CT findings prompted a change in management in 46 (23%) patients; 25 of these resulted in life-extending treatments and 21 had forgoing of life-sustaining treatments within 24 hours. 26 patients with PRISM score greater than 30% underwent CT; 23 (88%) of these were portable. More portable versus fixed examinations were performed in patients requiring extracorporeal membrane oxygenation, inhaled nitric oxide, high levels of positive end expiratory pressure, and those with high vasopressor scores (P < 0.05). Estimated patient dose from portable CT was 83 ± 6 mGy compared to 72 + 5 mGy for patients imaged on a fixed scanner (P < 0.0001).

Conclusion

Two-thirds of CT scans obtained in the PICU were portable because of patients’ intensity of therapy and illness severity. Portable CT showed major new pathology in greater than 1/3 and led to a change in management in 1/4 of higher acuity patients scanned. The estimated radiation dose from portable CT is within the current national guidelines.

Keywords

Computed tomography Bedside Portable Radiation Children Neurocritical care Critical illness 

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Copyright information

© Springer Science+Business Media, LLC 2011

Authors and Affiliations

  • Kerri L. LaRovere
    • 1
  • Molly S. Brett
    • 2
  • Robert C. Tasker
    • 1
    • 2
  • Keith J. Strauss
    • 3
  • Jeffrey P. Burns
    • 2
  • The Pediatric Critical Nervous System Program (pCNSp)
    • 1
    • 2
  1. 1.Department of NeurologyChildren’s Hospital BostonBostonUSA
  2. 2.Division of Critical Care Medicine, Department of Anesthesiology Perioperative and Pain MedicineChildren’s Hospital Boston and Harvard Medical SchoolBostonUSA
  3. 3.X-Ray Computations, IncWrenthamUSA

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