Ganzkörper-CT bei schwerverletzten Kindern. Ergebnisse einer retrospektiven Multizenterstudie anhand des TraumaRegister DGU^®

Zusammenfassung

Hintergrund: Eine schnelle und umfassende Diagnostik mittels Ganzkörper-CT ist in der Lage die Mortalität beim erwachsenen Traumapatienten zu reduzieren. Daher hat sich das Ganzkörper-CT zum Standard beim erwachsen Schwerverletzten etabliert. Wegen der höheren Strahlenbelastung gibt es um das Ganzkörper-CT im Kindesalter eine heftige Diskussion. Es ist nicht wirklich klar, ob das Ganzkörper-CT hier auch die Überlebenswahrscheinlichkeit verbessern kann.

Methode: In einer retrospektiven Multizenterstudie anhand der Daten das TraumaRegisters DGU^®, haben wir die Überlebenswahrscheinlichkeit anhand des „Revised Injury Severity Classification“ Scores und hieraus die Standarisierte Mortalitätsrate (SMR) berechnet. Die SMR ergibt sich als Quotient aus beobachteter zu prognostizierter Mortalität. Einschlusskriterien waren alle Kinder (1–15 Jahre) und Erwachsene (16–50 Jahre) mit einem ISS >9, die direkt vom Unfallort in eine Klinik eingewiesen wurden. Wir verglichen die Gruppen mit Ganzkörper-CT gegen die ohne Ganzkörper-CT (konventionelle Diagnostik). Für folgende Gruppen wurden Subanalysen durchgeführt: Kinder (1–9 Jahre), Kinder (10–15 Jahre) und Erwachsene.

Ergebnis: Insgesamt erfüllten 1 456 Kinder (Durchschnittsalter 9,9 Jahre) und 20 796 Erwachsene (Durchschnittsalter 32,7 Jahre) die Einschlusskriterien. Im Gegensatz zu den Erwachsenen, konnte für die Kinder kein Vorteil durch die Ganzkörper-CT nachgewiesen werden.

Schlussfolgerung: Wegen des fehlenden Vorteils der Ganzkörper-CT beim kindlichen Schwerverletzten und der höheren Strahlenbelastung hierdurch, erscheint zum jetzigen Zeitpunkt ein konventionelles diagnostisches Vorgehen gleichwertig, jedoch mit niedriger Strahlenbelastung.

Abstract

Background: A fast and comprehensive diagnostic by means of whole-body CT has been shown to reduce mortality in the adult trauma population. Therefore whole-body CT seems to be the standard in adult trauma-patients. Due to the higher radiation exposure of whole-body CT the use of this diagnostic toll in pediatric trauma patients is still under debate. It is not yet clear if whole-body CT in children can increase the probability of survival.

Method: In a retrospective, multicenter study, we used the data recorded in the TraumaRegister DGU^® to calculate the probability of survival according to the revised injury severity classification (RISC) and standardized mortality ratio (SMR). The SMR reflects the ratio of recorded to expected mortality. Included in the study were all children (1–15 years) and adults (16–50 years) with an Injury Severity Score (ISS)>9, who were directly admitted to the hospital from the scene of accident. We compared the groups of patients given whole-body CT or non-whole-body CT. Subgroup analysis was performed for children 1–9 years, children 10–15 years and adults.

Results: A total of 1 456 pediatric trauma patients (mean age 9.9 years) and 20 796 adults (mean age 32.7 years) were included in the study. In contrast to adult trauma patients, were the SMR in the whole-body CT group was significant lower; we observed no advantage for the whole-body CT in pediatric trauma patients.

Conclusion: Due to the missing advantage of whole-body CT in the pediatric trauma population and the higher radiation exposure of whole-body CT a non-whole-body CT approach seems equivalent with a lower radiation exposure.

Schlüsselwörter

Ganzkörper-CT - Kinder - Trauma - Outcome

Key words

whole-body CT - children - trauma - outcome

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