A Portable CT Scanner in the Pediatric Intensive Care Unit Decreases Transfer-Associated Adverse Events and Staff Disruption

Shruti Agrawal; Sara-Louise Hulme; Richard Hayward; Joe Brierley

doi:10.1007/s00068-009-9127-8

A Portable CT Scanner in the Pediatric Intensive Care Unit Decreases Transfer-Associated Adverse Events and Staff Disruption

Eur J Trauma Emerg Surg. 2010 Aug;36(4):346-52. doi: 10.1007/s00068-009-9127-8. Epub 2009 Nov 2.

Authors

Shruti Agrawal^{1

2}, Sara-Louise Hulme³, Richard Hayward⁴, Joe Brierley³

Affiliations

¹ Paediatric and Neonatal Intensive Care Unit, Institute of Child Health and Great Ormond Street Hospital for Children, London, UK. agraws1@gosh.nhs.uk.
² Paediatric and Neonatal Intensive Care Unit, Institute of Child Health and Great Ormond Street Hospital for Children, WC1N 3JH, London, UK. agraws1@gosh.nhs.uk.
³ Paediatric and Neonatal Intensive Care Unit, Institute of Child Health and Great Ormond Street Hospital for Children, London, UK.
⁴ Department of Paediatric Neurosurgery, Institute of Child Health and Great Ormond Street Hospital for Children, London, UK.

PMID: 26816039
DOI: 10.1007/s00068-009-9127-8

Abstract

Introduction: Computerized tomography (CT) is an important diagnostic tool in the management of critically ill children, especially those with neurosurgical problems such as traumatic brain injury. Traditionally, such scans require transfer to the radiology department (RD) at times of extreme physiological instability, such as incipient cerebral herniation, and exposes children with actual, or potential, spinal injuries to the risks of transfer. Moving children from pediatric intensive care (PIC), often overnight, also depletes units of senior staff. Portable CT (PCT) scanning offers a solution to this problem, and we assessed patient stability and staff time occupied during urgent CT scans before and after the introduction of a PCT scanner (CereTom(®)) in a regional neurosurgical pediatric intensive care unit (PICU).

Materials and methods: Prospective observational study of ventilated children in the PICU requiring urgent CT of the head to limit secondary brain injury. Data was collected for three months prior to, and for the same period after, the introduction of PCT on a questionnaire designed to assess physiological variables, PICU interventions, and staff time, which was completed immediately post scanning.

Results: Eight children had urgent CT head scan in the RD during the first 3 months and ten PCT in the second 6 months. The patients transferred to the RD required medical intervention because of cardio-respiratory instability or fluctuating intracranial pressure in nearly every patient and clearly increased the strain on staff resources. None of those patients undergoing PCT had untoward events and staff resources were far less impacted upon.

Discussion: PCT scanning is safe for unstable neurosurgical patients who need urgent diagnostic head CT, reducing the risks associated with transfer and the depletion of staff provision to the other children in the PICU. While this study did not specifically address image quality, all images were diagnostic regarding the indication for scanning.

Keywords: Head injury; Neurosurgery; Pediatrics; Portable CT imaging; Trauma.