61 - Variation in CT Scan Rates of Pediatric Trauma Patients Among Emergency Medicine-Trained and Pediatric Emergency Medicine-Trained Physicians

Poster Number: 61
Publication Number: 61.104

Aneta Pariaszevski, Stanford University School of Medicine, Sunnyvale, CA, United States; Nancy Ewen Wang, Stanford School of Medicine, Palo Alto, CA, United States; Andrea Fang, Stanford University School of Medicine, Palo Alto, CA, United States; Moon Lee, Stanford University School of Medicine, Palo Alto, CA, United States; Jason T. Lowe, Stanford University School of Medicine, Palo Alto, CA, United States; Dan Imler, Stanford University School of Medicine, West Menlo Park, CA, United States

Background: Pediatric trauma care has been shown to vary between general and pediatric emergency departments (EDs). Specifically, pediatric EDs do fewer CT scans with no change in clinical outcome. Why pediatric EDs scan fewer patients is unclear. Identifying factors associated with fewer CTs may decrease radiation exposure. Comparing factors between different institutions is difficult due to resource and systems variability; however, no pediatric trauma studies have evaluated general and pediatric EDs within the same institution. By eliminating institutional variability, we sought to identify whether the training background of ED providers affects the CT rate in pediatric trauma patients.

Objective: To compare CT rates of pediatric trauma patients treated within one institution by physicians trained in either emergency medicine or pediatric emergency medicine.

Design/Methods: This was a single-center retrospective study of children < 18 years entered into our Trauma Registry between Nov 2018 and Nov 2021. All patients within the study period were reviewed for CT utilization at our level 1 adult/pediatric trauma center. Attending physicians were categorized into three groups: emergency medicine residency (EM), pediatrics residency/pediatric emergency medicine fellowship (Peds-PEM), or emergency medicine residency/pediatric emergency medicine fellowship (EM-PEM). Primary outcomes were proportion of patients with a CT and percent positive CTs. Groups were compared χ-square analysis and association quantified with odds ratios, designating p-values < 0.05 as statistically significant. Patients were stratified by demographics and injury severity.

Results: Of 821 study patients, 402/821 (49.0%) patients received at least one CT scan. CTs were obtained in 218/397 (54.9%) patients treated by the EM group, 159/358 (44.4%) in the Peds-PEM group, and 25/66 (37.9%) in the EM-PEM group [χ2 (2, Nf 821)= 11.83, p= .003]. CT rates were statistically significant between EM and Peds-PEM (OR 1.52, 1.14-2.03), EM and EM-PEM (OR 2.00, 1.17-3.41), but not Peds-PEM and EM-PEM (OR 1.31, 0.76-2.25). In total, 982 CT scans were done with 256 (26.1%) positive findings, with no difference between EM (152/568, 26.8%), Peds-PEM (90/364, 24.7%), and EM-PEM (14/50, 28.0%) groups, [χ2 (2, Nf 982)= 0.58, p= .749].Conclusion(s): EM-trained providers obtained more CTs of pediatric trauma patients than either Peds-PEM or EM-PEM providers without a change in the CT positive rate. Peds-PEM and EM-PEM physicians performed similarly, which suggests specialty training in PEM and its subsequent implications could decrease radiation in trauma.
CV_Pariaszevski_2022.pdf