Efficacy of chest CT in a pediatric ICU - A prospective study

Study objectives: (1) To determine whether chest CT provides additional inf ormation compared with chest radiography regarding the nature elf intrathor acic disease in critically ill children, (2) to determine whether such info rmation alters clinical management, (3) to assess the role of a low-dose hi gh-resolution CT (HRCT) protocol in pediatric ICU (PICU) patients. Design: prospective study. Setting: Specialized PICU in a teaching hospital serving London and the sou th of England. Patients: Twenty children (age range, 3 weeks to 12 years; median, 11 month s) underwent chest CT during a 33-month period Inclusion criteria were (1) inconclusive diagnosis from chest radiograph (CXR) or (2) CXR appearances i nconsistent with high oxygenation or ventilatory requirements (Pao, to frac tion of inspired oxygen ratio < 30 or mean airway pressure > 15 cm H2O). Interventions: Low-dose HRCT scans (50 mA, 2-mm slice thickness at interval s of 10 or 15 mm) were performed on 12 patients, and helical CT (50 to 250 mA; pitch, 1 to 1.5) performed on 8 patients. Measurements and results: CT provided additional information regarding the nature of intrathoracic disease in 17 of 20 patients (85%) and resulted in changes to subsequent clinical management in 12 of 20 patients (60%). Conclusions: Chest CT can add to the accuracy of intrathoracic diagnosis pr ovided by the CXR and may directly influence the acute management of critic ally ill children. The CT protocol should be tailored to the clinical and r adiologic question posed Tor each individual patient. Noncontiguous HRCT ca n often provide accurate assessment of pulmonary parenchymal and pleural di sease at a reduced radiation dose compared with helical CT.