American Academy of Pediatrics – Section on Surgery
View all recommendations from this societyNovember 4, 2019
Avoid the routine use of whole-body computed tomography (CT) scanning (pan-scanning) in pediatric trauma patients.
While CT scans can be a helpful adjunct to diagnosing traumatic injuries, their usage should be tailored to the mechanism of injury and clinical findings. Radiation from CT scans places children at a low, but real risk of developing potentially fatal malignancies later in life. Decision rules have been developed to guide the judicious use of CT scans for evaluating traumatic head, cervical spine, chest, and abdominal/pelvic injuries. Chest CTs, in particular, have limited value in the evaluation of pediatric blunt trauma patients as few findings require specific treatments that change management. Adherence to published guidelines helps reduce unnecessary scans and reduce costs while minimizing significant missed injuries.
These items are provided solely for informational purposes and are not intended as a substitute for consultation with a medical professional. Patients with any specific questions about the items on this list or their individual situation should consult their physician.
How The List Was Created
Members of the American Academy of Pediatrics Section on Surgery Subcommittee on Education and Delivery of Surgical Care submitted the top 5 topics for Choosing Wisely items based on a review of the literature and expert opinion. The items were refined, ranked and approved by the Section on Surgery leadership. The list was then reviewed and approved by more than a dozen relevant AAP Committees, Councils and Sections. The AAP Executive Committee granted final approval of the list.
AAP’s disclosure and conflict of interest policy can be found at www.aap.org.
Sources
Brenner DJ, Hall EJ. Computed tomography – an increasing source of radiation exposure. N Engl J Med. 2007; 357:2277-2284.
Pearce MS, Salotti JA, et al. Radiation exposure from CT scans in childhood and subsequent risk of leukaemia and brain tumours: A retrospective cohort study. Lancet [Internet] 2012 Aug 4;380(9840):499–505.
Kuppermann N, Holmes JF et al. Pediatric Emergency Care Applied Research Network (PECARN). Identification of children at very low-risk of clinically-important brain injuries after head trauma: A prospective cohort study. Lancet [Internet]. 2009 Oct;374(9696):1160–1170.
Hoffman JR, Mower WR, et al. Validity of a set of clinical criteria to rule out injury to the cervical spine in patients with blunt trauma. National Emergency X-Radiography Utilization Study Group. N Engl J Med. 2000 Jul 13;343(2):94-99.
Leonard JC. Pediatr Clin North Am. 2013 Oct;60(5):1123-1137.
Stephens CQ, Boulos MC, et al. Limiting thoracic CT: a rule for use during initial pediatric trauma evaluation. J Pediatr Surg. 2017 Dec;52(12):2031-2037.
Streck CJ, Vogel AM, et al.; Pediatric Surgery Research Collaborative. Identifying children at very low risk for blunt intra-abdominal injury in whom CT of the abdomen can be avoided safely. J Am Coll Surg. 2017 Apr;224(4):449-458.
