Establishing an imaging protocol for pediatric trauma in a rural hospital

Abstract

Background: Rural hospitals cover 20% of the United States (US) population with only 10% of physician coverage. A mismatch exists in pediatric trauma resources as there is overwhelming trauma support concentrated in urban trauma centers. Well-established guidelines for evaluating pediatric trauma patients in resource-limited environments are currently not available. Herein we identify the imaging practices at a level III rural trauma center to establish a protocol for handling pediatric traumas. Materials and Methods: The National Trauma Data Bank was used to identify 155 pediatric trauma patients (age <17 years) between 2017 and 2021. A single-center retrospective chart review was performed to identify patient demographics, mechanism of injury, imaging performed and pertinent imaging findings, and management of the patient i.e., whether they were discharged, admitted, or transferred. Results: Blunt mechanisms were responsible for most traumas (90%). There were 64 patients (41.3%) who received imaging. Falls (49.3%) were the most common injury. Most of the patients were discharged home (73.4%) and 23.9% were transferred to a tertiary center. The mean time for transfer to a tertiary center was ∼176 min. The most frequently performed type of surgical intervention was orthopedic (59.3%). Conclusion: An established pediatric trauma imaging protocol is warranted to adopt a higher level of pediatric trauma care for treatment and/or stabilization purposes. Using a tertiary care model and established pediatric trauma guidelines, we propose a model for use in resource-limited rural settings and aim to reduce unnecessary imaging of pediatric trauma patients and overall radiation exposure.

Keywords

• Pediatric trauma
• Trauma imaging
• Imaging guidelines
• Radiation exposure
• Rural trauma center