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The Use of Whole Body CT Scans in Pediatric Trauma Patients: Are there Differences among Adult and Pediatric Centers?
S78
J Am Coll Surg
Surgical Forum Abstracts
Table. Incidence of pyloric stenosis by pesticide exposure among Indiana counties County by pesticide level
High pesticide counties Moderate pesticide counties Low pesticide counties
Demographic Characteristics Adult center (n¼18,919)
Pediatric center (n¼11,748)
pValue
Age, y, mean SD
12.89 5.8
10.13 6.17
0.14
Hypotensive GCS 8 ISS 25 Head AIS 3 Thorax AIS 3 Abdominal AIS 3
3.1% 8.3% 9.8% 34.7% 18.3% 16.8%
5.9% 7.9% 9.8% 35.3% 18.1% 16.4%
0.001 0.1 0.79 0.28 0.65 0.1
95% CI (per 10,000) Incidence (per 10,000)
p Value vs high counties
lower
upper
36
32
39
29
27
32
0.003
26
23
29
<0.0001
between PS and pesticide use was found to interact for most known risk factors (male sex, race, maternal education, maternal age, plurality, diabetes and tobacco use.) The Use of Whole Body CT Scans in Pediatric Trauma Patients: Are there Differences among Adult and Pediatric Centers? Maria Michailidou, MD, Bellal Joseph, MD, FACS, Viraj Pandit, MD, Narong Kulvatunyou, MD, FACS, Andrew L Tang, MD, FACS, Terence O’Keeffe, MBchB, FACS, Randall S Friese, MD, FACS, Fizan Abdullah, MD, PhD, Dylan Stewart, MD, Peter M Rhee, MD, FACS University of Arizona, Tucson, AZ, Johns Hopkins University School of Medicine, Baltimore, MD INTRODUCTION: The use of CT scan has become the standard of care for the initial assessment of trauma patients.Whole body CT (WBCT) scan is associated with significant radiation risk especially in pediatric trauma patients. The aim of this study was to assess the use WBCT scan across trauma centers for the management of pediatric trauma patients. METHODS: We performed a 2-year (2011-2012) retrospective analysis of the National Trauma Data Bank. Pediatric (age 18 years) trauma patients managed in level I or II adult or pediatric trauma centers with a head,thoracic or abdominal CT scan were included. WBCT scan was defined as CT scan of the head, thorax, and abdomen. Patients were stratified into two groups: patients managed in adult centers and patients managed in designated pediatric centers. Outcomes measure was use of WBCT. Multivariate logistic regression analysis was performed. RESULTS: A total of 30,667 patients were included of which 38.3% (n¼11,748) were managed in designated pediatric centers. 26.1% (n¼8,013) patients received a WBCT. The use of WBCT scan was significantly higher in adult trauma centers in comparison to pediatric centers (31.4% vs 17.6%, p¼0.001). There was no difference in mortality rate between the two groups (2.2% vs 2.1%, p¼0.37). After adjusting for all confounding factors,pediatric patients managed in adult centers were 1.8 times more likely to receive a WBCT compared to patients managed in pediatric centers (OR[95%CI]:1.8[1.3-2.1], p¼0.001) (Table).
CONCLUSIONS: Variability exists in the use of WBCT scan for pediatric trauma across trauma centers. Pediatric patients managed in adult trauma centers were more likely to be managed with WBCT, increasing their risk for radiation without a difference in outcomes. Establishing guidelines for minimizing the use of WBCT is warranted. Breast Imaging-Reporting and Data System (BIRADS) Classification in 51 Excised Palpable Pediatric Breast Masses Jeffrey L Koning, MD, Katherine P Davenport, MD, Patricia S Poole, MD, Peter G Kruk, MD, Julia E Grabowski, MD University of California, San Diego, San Diego, CA, Rady Children’s Hospital San Diego, San Diego, CA, San Diego Imaging Medical Group, San Diego, CA INTRODUCTION: The American College of Radiology BIRADS classification was developed to risk stratify breast lesions and guide surgical management based on imaging. Previous studies validating BIRADS for US do not include pediatric patients. Most pediatric breast masses present as a palpable lesion and frequently undergo a diagnostic ultrasound, which is often accompanied with a BIRADS classification. Our study aimed to correlate BIRADS with pathology findings to assess applicability of the classification system to pediatric patients. METHODS: We performed a retrospective review of all patients who underwent excision of a breast mass at a single center from July 2010 to November 2013. We identified all patients who BIRADS
n
Pathology (n)
0 1 2
2 0 7
3
17
4
25
Fibroadenoma (2) N/A Fibroadenoma (5), Juvenile fibroadenoma (1) , myxoid fibroadenoma (1) Fibroadenoma (16), Pseudoangiomatous stromal hyperplasia (PASH) (1) Fibroadenoma (22), tubular adenoma (3)
J Am Coll Surg
Surgical Forum Abstracts
Table. Incidence of pyloric stenosis by pesticide exposure among Indiana counties County by pesticide level
High pesticide counties Moderate pesticide counties Low pesticide counties
Demographic Characteristics Adult center (n¼18,919)
Pediatric center (n¼11,748)
pValue
Age, y, mean SD
12.89 5.8
10.13 6.17
0.14
Hypotensive GCS 8 ISS 25 Head AIS 3 Thorax AIS 3 Abdominal AIS 3
3.1% 8.3% 9.8% 34.7% 18.3% 16.8%
5.9% 7.9% 9.8% 35.3% 18.1% 16.4%
0.001 0.1 0.79 0.28 0.65 0.1
95% CI (per 10,000) Incidence (per 10,000)
p Value vs high counties
lower
upper
36
32
39
29
27
32
0.003
26
23
29
<0.0001
between PS and pesticide use was found to interact for most known risk factors (male sex, race, maternal education, maternal age, plurality, diabetes and tobacco use.) The Use of Whole Body CT Scans in Pediatric Trauma Patients: Are there Differences among Adult and Pediatric Centers? Maria Michailidou, MD, Bellal Joseph, MD, FACS, Viraj Pandit, MD, Narong Kulvatunyou, MD, FACS, Andrew L Tang, MD, FACS, Terence O’Keeffe, MBchB, FACS, Randall S Friese, MD, FACS, Fizan Abdullah, MD, PhD, Dylan Stewart, MD, Peter M Rhee, MD, FACS University of Arizona, Tucson, AZ, Johns Hopkins University School of Medicine, Baltimore, MD INTRODUCTION: The use of CT scan has become the standard of care for the initial assessment of trauma patients.Whole body CT (WBCT) scan is associated with significant radiation risk especially in pediatric trauma patients. The aim of this study was to assess the use WBCT scan across trauma centers for the management of pediatric trauma patients. METHODS: We performed a 2-year (2011-2012) retrospective analysis of the National Trauma Data Bank. Pediatric (age 18 years) trauma patients managed in level I or II adult or pediatric trauma centers with a head,thoracic or abdominal CT scan were included. WBCT scan was defined as CT scan of the head, thorax, and abdomen. Patients were stratified into two groups: patients managed in adult centers and patients managed in designated pediatric centers. Outcomes measure was use of WBCT. Multivariate logistic regression analysis was performed. RESULTS: A total of 30,667 patients were included of which 38.3% (n¼11,748) were managed in designated pediatric centers. 26.1% (n¼8,013) patients received a WBCT. The use of WBCT scan was significantly higher in adult trauma centers in comparison to pediatric centers (31.4% vs 17.6%, p¼0.001). There was no difference in mortality rate between the two groups (2.2% vs 2.1%, p¼0.37). After adjusting for all confounding factors,pediatric patients managed in adult centers were 1.8 times more likely to receive a WBCT compared to patients managed in pediatric centers (OR[95%CI]:1.8[1.3-2.1], p¼0.001) (Table).
CONCLUSIONS: Variability exists in the use of WBCT scan for pediatric trauma across trauma centers. Pediatric patients managed in adult trauma centers were more likely to be managed with WBCT, increasing their risk for radiation without a difference in outcomes. Establishing guidelines for minimizing the use of WBCT is warranted. Breast Imaging-Reporting and Data System (BIRADS) Classification in 51 Excised Palpable Pediatric Breast Masses Jeffrey L Koning, MD, Katherine P Davenport, MD, Patricia S Poole, MD, Peter G Kruk, MD, Julia E Grabowski, MD University of California, San Diego, San Diego, CA, Rady Children’s Hospital San Diego, San Diego, CA, San Diego Imaging Medical Group, San Diego, CA INTRODUCTION: The American College of Radiology BIRADS classification was developed to risk stratify breast lesions and guide surgical management based on imaging. Previous studies validating BIRADS for US do not include pediatric patients. Most pediatric breast masses present as a palpable lesion and frequently undergo a diagnostic ultrasound, which is often accompanied with a BIRADS classification. Our study aimed to correlate BIRADS with pathology findings to assess applicability of the classification system to pediatric patients. METHODS: We performed a retrospective review of all patients who underwent excision of a breast mass at a single center from July 2010 to November 2013. We identified all patients who BIRADS
n
Pathology (n)
0 1 2
2 0 7
3
17
4
25
Fibroadenoma (2) N/A Fibroadenoma (5), Juvenile fibroadenoma (1) , myxoid fibroadenoma (1) Fibroadenoma (16), Pseudoangiomatous stromal hyperplasia (PASH) (1) Fibroadenoma (22), tubular adenoma (3)