Decreasing Exposure to Radiation for Pediatric Complicated Pneumonia: Replacing Computed Tomography with Ultrasound
Several studies suggest the use of chest ultrasound (US) as an equal alternative to computed tomography (CT) scans for diagnosis and to guide treatment for complicated pneumonia, thereby decreasing exposure to radiation. Within the four year period of this study, a complicated pneumonia algorithm was initiated (April 2013), which specifies preference for chest US over chest CT scan.
The goal of this study was to evaluate the impact on illness and hospital course given a change in radiographic evaluation.
This is a single-center, retrospective study of patients hospitalized during 2010-2014 with diagnosis of complicated pneumonia. Patients included were identified by diagnosis code for pneumonia and an additional qualifier: chest CT, chest US, or pleural culture. Then, each case was manually reviewed to ensure it met the diagnosis by clinical definition. Baseline demographics and variables were collected for the study population. The following variables were compared pre- and post-algorithm implementation: intensive care unit (ICU) admission rates, ICU length of stay (LOS), hospital LOS, days with a chest tube, rate of chest tube insertion, complications (necrotizing pneumonia, pneumothorax, abscess, and return to OR after chest tube insertion), and number of antibiotics received.
The total number of patients included in the study was 296, 49% being male, with a median age of 5.4 years. Median length of stay was 9 days and 43% of cases were admitted to the ICU. Figure 1 shows the distribution of bacteria identified. We found that the number of ordered chest CTs decreased with a corresponding rise of chest USs during the study period (Figure 2). There was a statistically significant decrease in the number of patients who received a chest CT scan and increase in patients who received a chest US (p<0.0001) after the implementation of the algorithm. There was no significant difference seen in any of the other variables.
The introduction of an algorithm for the management of complicated pneumonia at our institution combined with an effort among physicians to change practice, led to significant reduction in chest CT use and increase in chest US use. This change in practice reduced radiation exposure to children.
M. Fernandez, None
K. Merkel, None
T. Meyer, None
L. Thoreson, None
S. Hauger, None