Head Computed Tomography Scanning During Pediatric Neurocritical Care: Diagnostic Yield and the Utility of Portable Studies
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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).
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.
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).
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.
KeywordsComputed tomography Bedside Portable Radiation Children Neurocritical care Critical illness
The authors would like to thank all staff at Children’s Hospital Boston who participated in the care of these patients. The Pediatric Critical Nervous System Program (pCNSp) is comprised of the Neurocritical Care ICU service, the Critical Care Neurology consult service, the neurosurgical service, and neuroradiology. The authors also thank Matthew Gregas for statistical support; Patricia Berry, Charles Hornberger, and Peter Betit for database support; and Alison Clapp for librarian support. This research was funded by the Department of Anesthesia at Children’s Hospital Boston.
Conflict of interest
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