In children, CT scans have more downsides than benefits. Often, no extra information is obtained and non-radiation alternatives are equally suitable. This conclusion was presented by surgeon David Nellensteijn, who defended his thesis ‘Paediatric abdominal injury: Initial treatment and diagnostics’ on April 1st, 2015, at the university of Groningen.
Abdominal injury accounts for ten percent of all traumas in children. However, the damage may not be evident at first sight and constitutes the leading cause of initially unrecognized fatal injury. Careful examination and exclusion of serious internal damage are therefore vital for incoming trauma patients. In adults, physical examination in combination with ultrasonography and CT imaging is used for diagnostics.
The surgeon investigated whether CT imaging indeed provides additional information in children with suspected abdominal injury. This was not the case: 96 percent of the planned interventions remained unchanged after the medical imaging procedure. Repetitive physical examination, blood analysis and ultrasonography were in most cases sufficient for accurate diagnosis. Additionally, CT imaging has several disadvantages, such as serious ionizing radiation hazards, the duration of the procedure and the dangers of transporting an acute patient to the less safe CT suite.
Nellensteijn knows it will not be easy to abandon CT imaging in the case of young patients. “First of all, doctors always fear they will miss something”, he says, “and second, doctors are afraid of being accused of negligence, because no CT scan was performed.” However, he hopes that his dissertation will make physicians more aware of the dangers of ionising radiation in children, so its use will get as low as reasonably achievable. The UMCG already set an example by changing the guidelines for CT imaging in children.
Sources: UMCG and thesis of David Nellensteijn
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