Variation in Pediatric Head CT Imaging Protocols in Washington State

Purpose: To examine variation in pediatric trauma head CT imaging protocols in Washington state. Methods: A web-based survey was sent to trauma-designated hospitals in Washington state. Respondents were queried about pediatric head trauma volumes, type of CT scanners, and technical information about the CT imaging protocols. Variation in pediatric trauma volumes, CT dose reduction strategies, and effective dose by trauma center levels was examined. Mean head effective dose and organ dose for a female baby were estimated. Results: We achieved a 76% overall response rate. Of the 2,215 children who received head CT scans, 36.3% (n=805) received head CT imaging at level 4 trauma center facilities, followed by level 1 trauma center (31.4%; n=695), level 3 trauma center (19.7%; n=436), level 2 trauma center (12%; n=267), and Level 5 (0.5%; n=12) facilities. Most responding trauma center facilities (44/47) reported having a pediatric specific imaging head CT protocols. However, compared to levels 1 and 2 trauma centers together, a greater proportion of levels 3, 4 & 5 trauma center facilities collectively lacked dose reduction strategies (0% vs. 25-57%), tended to have higher mAs (169 +/- 113 vs. 110 +/- 36), and were later adopters of dose reduction strategies on the CT scanners. There was more than a 10-fold variation in estimated median effective dose for a baby within level 4 trauma center facilities (3.5 +/- 0.84 mSv, range 0.60 to 9.60 mSv). Discussion: There is both within and between trauma center level variation in pediatric head CT imaging protocols and radiation dose in Washington state.