Validation of Decision Rules for CT Use in Children with Abdominal or Head Trauma

Project: Research projectResearch Project

Description

PROJECT SUMMARY/ABSTRACTIntra-abdominal injury (IAI) and traumatic brain injury (TBI) are the two leading causes of death in childrenolder than 1 year. Some IAIs and TBIs are difficult to identify, and failure to identify these injuries results inpreventable morbidity and mortality. Abdominal and cranial computerized tomography (CT) scanning havebecome the reference standard for diagnosing IAI and TBI, and CT use has significantly increased over thelast 30 years. CT scanning, however, has important risks, particularly the risk of radiation-induced malignancy.The risk of radiation-induced malignancy in young children is approximately one in 400 abdominal CT scansand one in 1,200 cranial CT scans. Currently, fewer than 10% of abdominal and cranial CT scans obtained ininjured children demonstrate IAI or TBI, thus, CT scanning is used inefficiently. This inefficiency is primarilydriven by physician concerns of missing injuries and the lack of rigorous evidence regarding indications for CTuse after trauma. We have previously derived clinical decision rules for the use of abdominal or cranial CTscanning in injured children. These rules were derived in large, diverse, multicenter populations, and are robustand precise; however, these rules have not yet been externally validated in a large, multicenter setting.Appropriate validation of derived clinical decision rules is required before clinical implementation. Suchvalidation should be performed in a large, diverse, multicenter population. The objectives of the current studyare to validate these previously derived, highly accurate generalizable decision rules for abdominal and cranialCT scanning in injured children. Once validated, these decision rules will then provide the evidence forappropriate use of CT in injured children. We will additionally collect data on CT use in children who are verylow risk for IAI or TBI by the decision rules. This information will then be used to assist in rule implementation.Implementation of these rules will allow for timely identification of children with IAI or TBI in need ofintervention, while avoiding CT scanning in children with minimal risk of such injuries. The study will be aprospective, multicenter observational validation study of children with blunt abdominal or head trauma at oneof six emergency departments in the national CTSA Emergency Care Translational Research Collaborative(ECTRC). The emergency departments of this consortium evaluate more than 300,000 children of diverseracial and ethnic backgrounds every year. More than 7,500 children with blunt abdominal and 20,000 childrenwith blunt head trauma will be enrolled over 3 ½ years at the participating centers. The variables in thepreviously derived decision rules will be collected prior to CT scanning such that validation of the decision rulescan be performed in an unbiased fashion. Successful validation of these rules will enable implementation of therules into clinical care and improve the care of injured children across the United States.
StatusActive
Effective start/end date7/15/165/31/21

Funding

  • National Institutes of Health: $701,305.00

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Craniocerebral Trauma
Tomography
Wounds and Injuries
Hospital Emergency Service
Radiation
Abdominal Injuries
Translational Medical Research
Validation Studies
Emergency Medical Services
Child Care
Population
Observational Studies
Cause of Death
Neoplasms
Traumatic Brain Injury
Morbidity
Physicians
Mortality