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Reflexionemos acerca de las dosis de radiación…..
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Pediatric trauma is usually a nonoperative experience for the pediatric general surgeon. The pediatric trauma surgeon resuscitates the child and then evaluates and triages the identified injuries. A common diagnostic tool is the computed tomography (CT) scan. Most children who require evaluation for significant trauma will get a CT scan, but there are no national guidelines directing the assessment. Injuries to the head, cervical spine, chest, and abdomen can all be imaged with a CT scan; the question is whether the liberal approach to imaging children is appropriate. Over the past decade, concern has arisen about the radiation dose delivered by CT. This concern has generated a national campaign to “image gently.” This article reviews the data involving the risk of medical radiation exposure and discusses strategies for managing the risk.
BACKGROUND: The amount of imaging studies performed for disease diagnosis has been rapidly increasing. We examined the amount of radiation exposure that pediatric trauma patients receive because they are an at-risk population. Our hypothesis was that pediatric trauma patients are exposed to high levels of radiation during a single hospital visit.
METHODS: Retrospective review of children who presented to Johns Hopkins Pediatric Trauma Center from July 1, 2004, to June 30, 2005. Radiographic studies were recorded for each patient and doses were calculated to give a total effective dose of radiation. All radiographic studies that each child received during evaluation, including any associated hospital admission, were included.
RESULTS: A total of 945 children were evaluated during the study year. A total of 719 children were included in the analysis. Mean age was 7.8 (+/-4.6) years. Four thousand six hundred three radiographic studies were performed; 1,457 were computed tomography (CT) studies (31.7%). Average radiation dose was 12.8 (+/-12) mSv. We found that while CT accounted for only 31.7% of the radiologic studies performed, it accounted for 91% of the total radiation dose. Mean dose for admitted children was 17.9 (+/-13.8) mSv. Mean dose for discharged children was 8.4 (+/-7.8) mSv (p < 0.0001). Burn injuries had the lowest radiation dose [1.2 (+/-2.6) mSv], whereas motor vehicle collision victims had the highest dose [18.8 (+/-14.7) mSv].
CONCLUSION: When the use of radiologic imaging is considered essential, cumulative radiation exposure can be high. In young children with relatively long life spans, the benefit of each imaging study and the cumulative radiation dose should be weighed against the long-term risks of increased exposure.
Borgeat A, Aguirre J. Update on local anesthetics. Curr Opin Anaesthesiol. 2010 Aug;23(4):466-71.
Department of Anesthesiology, Balgrist University Hospital, Zurich, Switzerland. alain.borgeat@balgrist.ch
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Division of General Surgery, Hospital for Sick Children, Toronto, Canada, M5G 1X8. a_ein@istar.ca
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Leer más »Duque-Estrada EO, Duarte MR, Rodrigues DM, Raphael MD. Wound infections in pediatric surgery: a study of 575 patients in a university hospital. Pediatr Surg Int. 2003 Aug;19(6):436-8. Epub 2003 Jul 22.
Hospital das Clínicas de Teresópolis, Av. Alberto Torres, s/n, Teresópolis, Rio de Janeiro, Brazil, 25950-000. duque@cremerj.com.br
Disponible en www.citeulike.org sccp
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Division of Pediatric Surgery, Department of Surgery, New York University School of Medicine, New York, New York 10016, USA. evan.nadler@med.nyu.edu
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