A Portable CT Scanner in the Pediatric Intensive Care Unit Decreases Transfer-Associated Adverse Events and Staff Disruption Shruti Agrawal 1 , Sara-Louise Hulme 1 , Richard Hayward 2 , Joe Brierley 1 Abstract Introduction: Computerized tomography (CT) is an important diagnostic tool in the management of crit- ically ill children, especially those with neurosurgical problems such as traumatic brain injury. Traditionally, such scans require transfer to the radiology depart- ment (RD) at times of extreme physiological instabil- ity, 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 Ò ) 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 vari- ables, 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 neuro- surgical 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. Key Words Pediatrics Æ Trauma Æ Head injury Æ Neurosurgery Æ Portable CT imaging Eur J Trauma Emerg Surg 2010;36:346–52 DOI 10.1007/s00068-009-9127-8 Introduction Computerized tomography (CT) is an important diag- nostic tool in the management of children with neu- rosurgical problems in pediatric intensive care (PIC), such as traumatic brain injury (TBI) with expanding extradural hematoma or acute hydrocephalus. It is often the definitive diagnostic evaluation in such chil- dren with worsening neurological conditions and helps to guide critical therapeutic interventions. Tradition- ally, such scans have required transfer to the radiology department (RD) at times of extreme physiological instability, such as cerebral herniation [1], and, fur- thermore, exposes children with actual, or potential, spinal injuries to the risks of transfer. Critically ill neurosurgical patients are on invasive multimodality monitoring and are often requiring regular complex therapeutic interventions, which must be continued during the transfer and scanning. It is well known that 1 Paediatric and Neonatal Intensive Care Unit, Institute of Child Health and Great Ormond Street Hospital for Children, London, UK, 2 Department of Paediatric Neurosurgery, Institute of Child Health and Great Ormond Street Hospital for Children, London, UK. Received: July 2, 2009; revision accepted: September 13, 2009; Published Online: November 2, 2009 European Journal of Trauma and Emergency Surgery Focus on Pediatric Polytrauma 346 Eur J Trauma Emerg Surg 2010 Æ No. 4 Ó URBAN &VOGEL