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- NoDisclosures
REDUCING IONIZING RADIATION EXPOSURE FROM CHEST CT IN THE EVALUATION - - PowerPoint PPT Presentation
REDUCING IONIZING RADIATION EXPOSURE FROM CHEST CT IN THE EVALUATION - - PowerPoint PPT Presentation
REDUCING IONIZING RADIATION EXPOSURE FROM CHEST CT IN THE EVALUATION OF THE INJURED CHILD: A QUALITY IMPROVEMENT PROJECT Megan Strawhacker, RN; Stephanie Haley-Andrews, RN; Genie Roosevelt, MD, MPH; Craig Gravitz, RN; Claudia Kunrath, MD;
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- A child’s risk of developing cancer from radiation exposure
is estimated to be as high as 1/500
- Children exposed to higher radiation doses than adults
- Chest CT did not change management of the patient
- Chest CT recommended - abnormal mediastinal
silhouette
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HYPOTHESIS
- Reduce the # of Chest CTs and radiation
exposure by:
- Provider Education
- Imaging Guidelines
- Robust Performance Improvement Program
- No missed significant or life threatening thoracic
injury
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METHODS
- Retrospective study
- 2010-2013 – Injured children under the age of 15 who underwent
Chest CT or Chest/Abdomen/Pelvis CT for blunt trauma
- 53 patients met criteria
- Provider Education initiated in 2012
- Imagine Guideline implemented in 2013
- Audit filter was developed
- Chest CTs reviewed monthly at Pediatric Trauma Committee
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IMAGING GUIDELINE
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RESULTS - DENVER HEALTH MEDICAL CENTER
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RESULTS – STATE OF COLORADO
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DENVER HEALTH & STATE OF CO
Denver Health Colorado 2010 9.00% 10.8% 2011 12.6% 9.8% 2012 7.3% 9.5% 2013 3.3% 6.5%
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COST SAVING BENEFITS
- Costs of CT scan
- 71250 w/o contrast $1,779.00
- 71260 w contrast $2,235.08
- 71270 w w/o contrast $2318.22
- Diagnostic Related Groups (DRG)
- Admitted patients - CT scan gets lumped into DRG
- Money deducted from reimbursement
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SUMMARY
- Selective CT imaging decreased the amount of ionizing
radiation exposure to children
- No missed life threatening thoracic injuries
- Education of providers reduced imaging but
implementation of imagining guidelines with monitoring was more effective
- Multidisciplinary PI program contributed to success
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WHERE DO WE GO FROM HERE?
- Abdominal/Pelvis CTs – imagining guideline
- Head CTs – imaging guideline based on PECARN
- Continue education to curtail liberal imaging of injured
children
- Monthly webinars
- Annual trauma & emergency medicine conference
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