Pediatric Trauma in the Emergency Department: Clinical Risk Stratification, CT Utilization and Radiation Burden in a Tertiary Care Cohort

TL;DR

This study examines CT scan use and radiation exposure in children with trauma, finding significant radiation burden even in low-risk cases.

Contribution

The study introduces a risk-stratified analysis of CT utilization and radiation exposure in pediatric trauma patients.

Findings

58.3% of 935 children underwent at least one CT scan.

Low-risk children contributed significantly to cumulative radiation burden.

Combined-region CT protocols disproportionately increased radiation doses.

Abstract

Background/Objective: Pediatric trauma frequently prompts computed tomography (CT) in emergency departments; however, the cumulative radiation burden and its distribution across initial clinical risk strata remain incompletely characterized. We aimed to describe CT utilization and cumulative effective dose in a tertiary care pediatric trauma cohort and examine how radiation exposure accrues across pragmatic presentation-based risk groups. Methods: We conducted a retrospective cohort audit of pediatric trauma presentations at our institution. Risk stratification was based on the triage category and readily available initial physiological parameters. CT utilization and radiation burden were assessed at the patient level using the cumulative effective dose (mSv) derived from scanner dose metrics and region-specific conversion coefficients. Secondary analyses examined the dose distribution according to ED disposition and consultation pathways. Sensitivity analyses were performed using green triage only as an “ultra-low-risk” definition. Results: Among the 935 children, 545 (58.3%) underwent at least one CT examination. Although higher-risk categories had higher CT use and higher per-patient dose, a substantial share of the cohort’s cumulative radiation burden accrued in children initially classified as low-risk and/or ultimately discharged. Combined-region CT protocols contributed disproportionately to the higher dose categories. The findings were consistent in sensitivity analyses using a stricter ultra-low-risk definition. Conclusions: In this single-center audit, CT utilization and cumulative radiation burden were high, and non-trivial radiation exposure accrued among children initially classified as low-risk. These findings support targeted radiation stewardship interventions, including pathway optimization and the implementation of validated decision tools, where feasible, particularly for discharge-eligible and low-risk presentations.

Figures