Skip to main content

Advertisement

SpringerLink
Log in

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

  • Original Article
  • Published:
Neurocritical Care Aims and scope Submit manuscript

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. McCunn M, Mirvis S, Reynolds N, Cottingham C. Physician utilization of a portable computed tomography scanner in the intensive care unit. Crit Care Med. 2000;28:3808–13.

    Article  PubMed  CAS  Google Scholar 

  2. Teichgraber UK, Pinkernelle J, Jurgensen JS, Ricke J, Kaisers U. Portable computed tomography performed on the intensive care unit. Intensiv Care Med. 2003;29:491–5.

    Google Scholar 

  3. Butler WE, Piaggio CM, Constantinou C, et al. A mobile computed tomographic scanner with intraoperative and intensive care unit applications. Neurosurgery. 1998;42:1304–10. Discussion 10–1.

    Article  PubMed  CAS  Google Scholar 

  4. Gunnarsson T, Theodorsson A, Karlsson P, et al. Mobile computerized tomography scanning in the neurosurgery intensive care unit: increase in patient safety and reduction of staff workload. J Neurosurg. 2000;93:432–6.

    Article  PubMed  CAS  Google Scholar 

  5. Mirvis SE. Use of portable CT in the R Adams Cowley Shock Trauma Center. Experiences in the admitting area, ICU, and operating room. Surg Clin North Am. 1999;79:1317–30.

    Article  PubMed  CAS  Google Scholar 

  6. Matson MB, Jarosz JM, Gallacher D, et al. Evaluation of head examinations produced with a mobile CT unit. Br J Radiol. 1999;72:631–6.

    PubMed  CAS  Google Scholar 

  7. Peace K, Wilensky EM, Frangos S, et al. The use of a portable head CT scanner in the intensive care unit. J Neurosci Nurs. 2010;42:109–16.

    Article  PubMed  Google Scholar 

  8. Rumboldt Z, Huda W, All JW. Review of portable CT with assessment of a dedicated head CT scanner. AJNR Am J Neuroradiol. 2009;30:1630–6.

    Article  PubMed  CAS  Google Scholar 

  9. Waydhas C. Intrahospital transport of critically ill patients. Crit Care. 1999;3:R83–9.

    Article  PubMed  CAS  Google Scholar 

  10. Lahner D, Nikolic A, Marhofer P, et al. Incidence of complications in intrahospital transport of critically ill patients—experience in an Austrian university hospital. Wien Klin Wochenschr. 2007;119:412–6.

    Article  PubMed  Google Scholar 

  11. Wallen E, Venkataraman ST, Grosso MJ, Kiene K, Orr RA. Intrahospital transport of critically ill pediatric patients. Crit Care Med. 1995;23:1588–95.

    Article  PubMed  CAS  Google Scholar 

  12. Tobias JD, Lynch A, Garrett J. Alterations of end-tidal carbon dioxide during the intrahospital transport of children. Pediatr Emerg Care. 1996;12:249–51.

    Article  PubMed  CAS  Google Scholar 

  13. Brenner DJ. Estimating cancer risks from pediatric CT: going from the qualitative to the quantitative. Pediatr Radiol. 2002;32:228–31. Discussion 42–4.

    Article  PubMed  Google Scholar 

  14. Brenner DJ, Hall EJ. Computed tomography—an increasing source of radiation exposure. N Engl J Med. 2007;357:2277–84.

    Article  PubMed  CAS  Google Scholar 

  15. Pollack MM, Ruttimann UE, Getson PR. Pediatric risk of mortality (PRISM) score. Crit Care Med. 1988;16:1110–6.

    Article  PubMed  CAS  Google Scholar 

  16. Wernovsky G, Wypij D, Jonas RA, et al. Postoperative course and hemodynamic profile after the arterial switch operation in neonates and infants. A comparison of low-flow cardiopulmonary bypass and circulatory arrest. Circulation. 1995;92:2226–35.

    PubMed  CAS  Google Scholar 

  17. Mobile computed tomography evaluation of the NeuroLogica CereTom. Health Devices. 2008;37(11):325–42.

  18. Fryback DG, Thornbury JR. The efficacy of diagnostic imaging. Med Decis Mak. 1991;11:88–94.

    Article  CAS  Google Scholar 

  19. Miller WT Jr, Tino G, Friedburg JS. Thoracic CT in the intensive care unit: assessment of clinical usefulness. Radiology. 1998;209:491–8.

    PubMed  Google Scholar 

  20. Maher MM, Hahn PF, Gervais DA, Seoighe B, Ravenscroft JB, Mueller PR. Portable abdominal CT: analysis of quality and clinical impact in more than 100 consecutive cases. AJR Am J Roentgenol. 2004;183:663–70.

    PubMed  Google Scholar 

  21. Indeck M, Peterson S, Smith J, Brotman S. Risk, cost, and benefit of transporting ICU patients for special studies. J Trauma. 1988;28:1020–5.

    Article  PubMed  CAS  Google Scholar 

  22. Stevens GC, Rowles NP, Foy RT, et al. The use of mobile computed tomography in intensive care: regulatory compliance and radiation protection. J Radiol Prot. 2009;29:483–90.

    Article  PubMed  CAS  Google Scholar 

  23. Brody AS, Frush DP, Huda W, Brent RL. Radiation risk to children from computed tomography. Pediatrics. 2007;120:677–82.

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

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

None.

Author information

Authors and Affiliations

  1. Department of Neurology, Children’s Hospital Boston, 300 Longwood Avenue, Boston, MA, 02115, USA

    Kerri L. LaRovere & Robert C. Tasker

  2. Division of Critical Care Medicine, Department of Anesthesiology Perioperative and Pain Medicine, Children’s Hospital Boston and Harvard Medical School, 300 Longwood Avenue, Boston, MA, 02115, USA

    Molly S. Brett, Robert C. Tasker & Jeffrey P. Burns

  3. X-Ray Computations, Inc, Wrentham, MA, 02093, USA

    Keith J. Strauss

Authors
  1. Kerri L. LaRovere
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Molly S. Brett
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Robert C. Tasker
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Keith J. Strauss
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Jeffrey P. Burns
    View author publications

    You can also search for this author in PubMed Google Scholar

Consortia

The Pediatric Critical Nervous System Program (pCNSp)

Corresponding author

Correspondence to Kerri L. LaRovere.

Additional information

The members of pCNSp are given in Appendix.

Appendix: pCNSp members

Appendix: pCNSp members

Neurocritical Care Program Robert Tasker (Chair, Departments of Neurology and Anesthesia).

Critical Care Neurology consult service (CCNS) Omar Khwaja, Janet Soul, David Urion, Mark Libenson, Michael Rivkin, Basil Darras, Mustafa Sahin.

Neurocritical Care ICU service From the Division of Critical Care Medicine: Jeffrey Burns (Chief, Division of Critical Care Medicine), John Arnold, Monica Kleinman, Robert Graham, Daniel Kohane, Thomas Mancuso, Michael McManus, Nilesh Mehta, Robert Pascucci, Gregory Priebe, Adrienne Randolph, Robert Truog, Meredith van der Velden, Sally Vitali, Peter Weinstock, Gerhard Wolf, Christopher Weldon. From the division of Cardiovascular Critical Care: Peter Laussen (Chief, Division of Cardiovascular Intensive Care), Melvin Almodovar, Ravi Thiagarajan, James DiNardo, Thomas Kulik, Joshua Salvin, Cindy Barrett, Sarah Teele, Catherine Allan, John Kheir, Vamsi Yarlagadda, Satish Rajagopal.

Neurosurgery R. Michael Scott (Chief, Department of Neurosurgery).

Neuroradiology Richard Robertson (Chief, Department of Radiology).

Rights and permissions

Reprints and permissions

About this article

Cite this article

LaRovere, K.L., Brett, M.S., Tasker, R.C. et al. Head Computed Tomography Scanning During Pediatric Neurocritical Care: Diagnostic Yield and the Utility of Portable Studies. Neurocrit Care 16, 251–257 (2012). https://doi.org/10.1007/s12028-011-9627-3

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12028-011-9627-3

Keywords

Search

Navigation