Evidence map›Paper›PMID 35505179›Full record

ArticleCJEM2022

Safely reducing abdominal/pelvic computed tomography imaging in pediatric trauma: a quality improvement initiative.

Suzanne Beno, Felicia Paluck, Talia Greenspoon, Daniel Rosenfield, Tania Principi

Abstract read
PubMed Publisher
In one paragraph

Article in CJEM, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 8 papers, 2 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
8citing papers in PubMed, 2 pooled it
1.5field-weighted citation impact, top 18% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

8 citing papers in PubMed, 2 syntheses or guidelines pooled it, 7 citations in OpenAlex.

  1. Pooled it
  2. Pooled it
  3. Trial
  4. CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne · 2026
    Article
  5. Blunt abdominal trauma in a 6-year-old boy and need for imaging.CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne · 2025
    Article
  6. Article
  7. Review
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4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

5 authors at 1 institution in 1 country.

Suzanne BenoDepartment of Paediatrics, Hospital for Sick Children, University of Toronto, Toronto, ON, Canada. suzanne.beno@sickkids.ca.ORCID 0000-0002-1340-4392
Felicia PaluckDepartment of Paediatrics, Hospital for Sick Children, University of Toronto, Toronto, ON, Canada.
Talia GreenspoonDepartment of Paediatrics, Hospital for Sick Children, University of Toronto, Toronto, ON, Canada.
Daniel RosenfieldDepartment of Paediatrics, Hospital for Sick Children, University of Toronto, Toronto, ON, Canada.
Tania PrincipiDepartment of Paediatrics, Hospital for Sick Children, University of Toronto, Toronto, ON, Canada.
University of Toronto · CA

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

objectiveIntra-abdominal injury occurs in less than 15% of pediatric trauma activations but can be life-threatening. Computed tomography (CT) imaging is commonly ordered in pediatric trauma, even when intra-abdominal injury risk is low. We aimed to reduce abdominal/pelvic CT rates in children at very low risk for intra-abdominal injury requiring trauma activation at our pediatric trauma centre.

methodsWe implemented a quality improvement initiative using the Model for Improvement in children 0-15.99 years of age who activated a trauma response and were evaluated for intra-abdominal injury. Interventions included clinical decision support, institutional education, and individual audit and feedback. Our primary outcome was abdominal/pelvic CT rate in patients at very low risk for intra-abdominal injury. Balancing measures included CT scans ordered within 24 h of emergency department (ED) assessment and return to ED or hospitalization within 72 h for missed intra-abdominal injury. Statistical process control was used to evaluate rates over time.

resultsThe baseline period (April 1, 2016 - November 30, 2017) included 359 trauma patients with a CT rate of 26.8% (95% CI 20.5-33.8%) in those at low risk for intra-abdominal injury. The intervention period (Dec 1, 2017-Dec 31, 2019) included 445 patients with a CT rate in low-risk patients of 6.8% (95% CI 3.2-12.6%), demonstrating an absolute reduction of 20.0% (95% CI 12.2-27.7%, p < 0.05). Interventions resulted in a significant decrease in abdominal/pelvic CT imaging corresponding with special cause variation. No clinically significant intra-abdominal injuries were missed.

conclusionsThis quality improvement initiative reduced abdominal/pelvic CT rates in pediatric trauma patients at low risk for intra-abdominal injury without any missed cases of significant injury. Leveraging standardized decision tools to reduce unnecessary CT imaging can be successfully accomplished without compromising care.

Indexed as

Abdominal InjuriesWounds, NonpenetratingChildEmergency Service, HospitalHumansQuality ImprovementRetrospective StudiesTomography, X-Ray ComputedCT imagingIntra-abdominal injuryLow riskPediatricQuality improvement

Identifiers

PMID35505179
OpenAlexW4225381380

What OpenQuestion holds

Textmetadata
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.